NPIMap

Organization Active NPI

Riverside Medical Center LLC

Doing business as Blue Rock Medical Center

  • Multi-Specialty Clinic/Center
  • Provo, UT
National Provider Identifier
1649567504
Registry record updated Nov 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
RIVERSIDE MEDICAL CENTER LLC
Doing business as
Blue Rock Medical Center
Practice address
3152 N University Ave Ste 100
Provo, UT 84604-4729
Phone
(801) 229-2002
Fax
(801) 229-1003
NPI assigned
Jun 29, 2011
Last updated
Nov 1, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2012

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

Authorized official

Name
Barbara Givens
Title
Office Manager
Phone
(801) 229-2002

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

3152 N University Ave Ste 100
Provo, UT 84604-4729

Mailing address

3152 N University Ave Ste 100
Provo, UT 84604-4729
Phone (801) 229-2002

Other names 1

  • Blue Rock Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131007001490 UT Part B Supplier - Clinic/Group Practice 7214161256 Receives reassigned benefits from 12 practitioners
Practice locations: Provo, UT

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2261257Riverside Medical Center3152 N University Ave, Provo, UT 84604Certificate of waiverMay 26, 2028

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

3152 N University Ave
Provo, UT 84604
Phone (801) 229-2002

3152 N University Ave
Ste 12
Provo, UT 84604

3152 N University Ave
Ste 120
Provo, UT 84604
Phone (801) 375-2177

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1309305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351728000000",
    "number": "1649567504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3152 N UNIVERSITY AVE STE 100",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044729",
            "telephone_number": "801-229-2002",
            "fax_number": "801-229-1003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3152 N UNIVERSITY AVE STE 100",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044729",
            "telephone_number": "801-229-2002",
            "fax_number": "801-229-1003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-29",
        "last_updated": "2012-11-01",
        "status": "A",
        "authorized_official_last_name": "GIVENS",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "801-229-2002"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Rock Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2012; 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.