Epic Prosthetics and Orthotics LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

EPIC PROSTHETICS AND ORTHOTICS LLC

Practice address

635 N Main St Ste 691
Richfield, UT 84701-1895

Phone

(801) 820-0087

Fax

(801) 820-2852

NPI assigned

Feb 7, 2022

Last updated

Dec 9, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jake Coburn Davis, CPO, MSPONPI 1841824521

Title

Owner/Clinical Manager

Phone

(801) 820-0045

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 1

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.

• Jake Coburn Davis, CPO, MSPO

  • Prosthetist
  • Richfield, UT
  • NPI 1841824521

  Orthotist

  NPD Authorized official

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

{
    "created_epoch": "1644192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670544000000",
    "number": "1629722889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 N MAIN ST STE 691",
            "city": "RICHFIELD",
            "state": "UT",
            "postal_code": "847011895",
            "telephone_number": "801-820-0087",
            "fax_number": "801-820-2852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 N MAIN ST STE 691",
            "city": "RICHFIELD",
            "state": "UT",
            "postal_code": "847011895",
            "telephone_number": "801-820-0087",
            "fax_number": "801-820-2852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPIC PROSTHETICS AND ORTHOTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-07",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JAKE",
        "authorized_official_middle_name": "COBURN",
        "authorized_official_title_or_position": "OWNER/CLINICAL MANAGER",
        "authorized_official_telephone_number": "801-820-0045",
        "authorized_official_credential": "CPO, MSPO"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@epicpo.com",
            "affiliation": "N",
            "endpointDescription": "Secure Healthcare Google Business Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "N/A",
            "address_1": "635 N Main St Ste 691",
            "city": "Richfield",
            "state": "UT",
            "country_code": "US",
            "postal_code": "847011895",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dakota Eckersley
• Curtis Eliason
• Lisa K Ellingford, CPM
• Sara Autumn Ellsworth
• Kilee Elmer
• Ashley Evans
• Desra Evans
• Christopher Stanley Evensen, D.O.
• Troy Jonathan Faddis, LMFT
• Kirsten L Fails, PT

• Prosthetic/Orthotic Supplier in Richfield, UT
• Providers in Richfield, UT by specialty
• Prosthetic/Orthotic Supplier in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.