NPIMap

Organization Active NPI

Integrated Functional Medicine

  • General Practice Physician
  • Bountiful, UT
National Provider Identifier
1629407697
Registry record updated Nov 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
INTEGRATED FUNCTIONAL MEDICINE
Practice address
458 N 500 W
Bountiful, UT 84010-6948
Phone
(801) 292-9355
Fax
(801) 296-8050
NPI assigned
Nov 11, 2013
Last updated
Nov 11, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cory FrogleyNPI 1033168372
Title
Owner
Phone
(801) 292-9355

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

458 N 500 W
Bountiful, UT 84010-6948

Mailing address

458 N 500 W
Bountiful, UT 84010-6948
Phone (801) 292-9355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140226001532 UT Part B Supplier - Clinic/Group Practice 4789814351 Receives reassigned benefits from 24 practitioners
3 other NPIs on this enrollment
Practice locations: Bountiful, UT; Salt Lake City, UT; South Jordan, UT
O20200520002590 UT DME Supplier - Medical Supply Company With Orthotic-Prosthetic 4789814351 Practice locations: Bountiful, UT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384128000000",
    "number": "1629407697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "458 N 500 W",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106948",
            "telephone_number": "801-292-9355",
            "fax_number": "801-296-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "458 N 500 W",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106948",
            "telephone_number": "801-292-9355",
            "fax_number": "801-296-8050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED FUNCTIONAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-11",
        "last_updated": "2013-11-11",
        "status": "A",
        "authorized_official_last_name": "FROGLEY",
        "authorized_official_first_name": "CORY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-292-9355"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bountiful, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.