NPIMap

Organization Active NPI

R Jeffrey Parker MD a Professional Corporation

  • Ophthalmology Physician
  • St George, UT
National Provider Identifier
1669410098
Registry record updated Mar 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
963214201205 Issued in UT
Legal business name
R JEFFREY PARKER MD A PROFESSIONAL CORPORATION
Practice address
1791 E 280 N
St George, UT 84790-2400
Phone
(702) 369-0200
Fax
(702) 243-8383
NPI assigned
Jun 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2023

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

Authorized official

Name
Amy Grim
Title
Credentialing Specialist
Phone
(702) 202-4776

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 963214201205 UT Primary

Addresses

Primary practice location

1791 E 280 N
St George, UT 84790-2400

Mailing address

3006 S Maryland Parkway
Suite 710
Las Vegas, NV 89109
Phone (702) 369-0200

Other identifiers 1

IdentifierTypeStateIssuer
530401246018MedicaidUT

Other names 1

  • Retina Consultants of Southern Utah Doing business as

National Provider Directory

National Provider Directory

Locations

653 N Town Center Dr
Ste 518
Las Vegas, NV 89144

1791 E 280 N
#O
St George, UT 84790

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680048000000",
    "number": "1669410098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3006 S MARYLAND PARKWAY",
            "address_2": "SUITE 710",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89109",
            "telephone_number": "702-369-0200",
            "fax_number": "702-243-8383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1791 E 280 N",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847902400",
            "telephone_number": "702-369-0200",
            "fax_number": "702-243-8383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R JEFFREY PARKER MD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A",
        "authorized_official_last_name": "GRIM",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "702-202-4776"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "UT",
            "license": "963214201205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "530401246018",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Retina Consultants of Southern Utah",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Retina Consultants of Southern Utah",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St George, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.