Individual provider Active NPI

Richard John, DO

  • Family Medicine Physician
  • Logan, UT
National Provider Identifier
1649894692
Registry record updated Nov 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
13421605-8904 Issued in UT
Practice address
1350 N 500 E
Logan, UT 84341-2400
Phone
(208) 234-4700
NPI assigned
Jun 5, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 13421605-8904 UT Primary

Addresses

Primary practice location

1350 N 500 E
Logan, UT 84341-2400

Mailing address

1350 N 500 E
Logan, UT 84341-2400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230830003213 UT Practitioner - Family Practice 3678995263 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Liberty Univ College of Osteopathic Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Impact Physician Group LLCGroup PAC ID 6204199086, 26 clinicians
Tanner Memorial ClinicGroup PAC ID 4284547985, 251 clinicians

Practice addresses (Care Compare)

306 W River Bend LN
Provo, UT 84604-5625
Phone (801) 226-8880

425 S 100
Layton, UT 84041-5356
Phone (801) 773-4840

5825 Harrison Blvd
South Ogden, UT 84403-4316
Phone (801) 475-5254

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
13421605-8904UTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Utah Regional Hospitalists LLC CurrentSince Jul 17, 2023 Accepting new patients
Tanner Memorial Clinic CurrentSince Jun 1, 2024 Accepting new patients
Tanner Memorial Clinic Current Accepting new patients
Impact Physician Group, LLC CurrentSince Mar 6, 2024 Accepting new patients
Tanner Memorial Clinic CurrentSince Jun 1, 2024 Accepting new patients
Utah Regional Hospitalists LLC CurrentSince Jul 17, 2023 Accepting new patients
Rosenberg Cooley Metcalf LC Past Accepting new patients

Locations

11925 S State St
Draper, UT 84020
Phone (801) 545-8000

425 S 100 W
Layton, UT 84041
Phone (801) 682-8708

1600 W Antelope Dr
Layton, UT 84041
Phone (801) 807-1000

5825 Harrison Blvd
South Ogden, UT 84403
Phone (801) 475-5254

306 W River Bend Ln
Sundance, UT 84604
Phone (801) 226-5838

3460 S Pioneer Pkwy
West Valley City, UT 84120
Phone (801) 964-3111

Interoperability endpoints

  • Direct secure messaging: richard.john.p1@direct.tannerclinic.nextgenshare.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1591315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1649894692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 N 500 E",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 N 500 E",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412400",
            "telephone_number": "208-234-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHN",
        "first_name": "RICHARD",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-05",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "13421605-8904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, UT

Sources for this page

Verify at the official NPI Registry.