Integrated Functional Medicine
Organization Active NPI General Practice Physician · Bountiful, UT
NPI 1629407697 · NPPES record last updated Nov 11, 2013
Key facts
- NPI
- 1629407697
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 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
- Organization subpart
- No
Authorized official
- Name
- Cory Frogley
- Title
- Owner
- Phone
- (801) 292-9355
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 1
Practitioners 26
-
Aaron Eugene Frodsham, M.D.
-
Vikas Garg, M.D.
-
Diane Wendy Hagen, M.P.T
-
Angela Lee Ivester, CRNA
-
Laura Prater Geoghegan, APRN
-
Kristina Michelle Reed, M.D.
-
Bradley J Jones, PT
-
Samuel Force, PA-C
-
Julia Libby, DPT
-
Brittaney Lee Cahoon, FNP-C
-
Kirk R Wersland, DC
-
Seth Bires, DO
-
Miles Tsujimoto, DC
-
Desiree S Hammer, PA
-
Jared Lane, DC
-
Tyler Lile, DC
-
Becky Jo Barnett, D.P.T.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
151 E 5600 S
Ste 104
Salt Lake Cty, UT 84107
Phone (801) 816-0332
4624 S Holladay Blvd
Ste 202
Salt Lake Cty, UT 84117
Phone (385) 800-5015
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | Yes |
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
Other providers in Bountiful, UT
- Ihc Health Services Inc
- Ihc Health Services Inc
- Patrick Edward Imperio
- Austin Blair Imus
- Independence Physician and Resource
- Integrated Functional Medicine, LLC
- Integrated Wellness Group LLC
- Integrated Wellness Group LLC
- Integrated Wellness of Salt Lake
- Integrative Functional Nutrition
All providers in Bountiful, UT · General Practice Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.