NPIMap

Individual provider Active NPI

L. Scott Vanwagoner, DO

  • Emergency Medical Services (Emergency Medicine) Physician
  • American Fork, UT
National Provider Identifier
1669425146
Registry record updated Feb 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
359724 Issued in UT
Practice address
170 North 1100 East
American Fork, UT 84003
Phone
(801) 714-6570
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 359724 UT Primary

Addresses

Primary practice location

170 North 1100 East
American Fork, UT 84003

Mailing address

PO Box 430
Salt Lake City, UT 84660-0430
Phone (866) 898-7136

Other identifiers 4

IdentifierTypeStateIssuer
659871OtherUTDESERET MUTUAL
870636000VA1OtherUTEDUCATORS MUTUAL
107009651102OtherUTSELECT HEALTH
D2495MedicaidUT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041215000216 UT Practitioner - Emergency Medicine 4486611035 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Valley Emergency Physicians LCGroup PAC ID 4789630401, 16 clinicians

Practice addresses (Care Compare)

170 N 1100
American Fork, UT 84003-2096
Phone (801) 714-6570

Hospital & facility affiliations

  • American Fork Hospital Hospital, American Fork, UT, CCN 460023

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
359724UTMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Valley Emergency Physicians LC Emergency Medical Services CurrentSince Mar 25, 2005 Accepting new patients
Ihc Health Services, Inc. Past Accepting new patients
Utah Valley Emergency Physicians Inc Emergency Medicine PastSince Dec 15, 2019 Accepting new patients
University of Utah Emergency Physicians Emergency Medicine Past Accepting new patients
University of Utah Emergency Physicians Emergency Medical Services Past Accepting new patients

Locations

170 N 1100 E
American Fork, UT 84003
Phone (801) 714-6570

Organizations & group practices 5

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 2

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": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265846400000",
    "number": "1669425146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 430",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "846600430",
            "telephone_number": "866-898-7136",
            "fax_number": "616-975-9827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 NORTH 1100 EAST",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "84003",
            "telephone_number": "801-714-6570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANWAGONER",
        "first_name": "L. SCOTT",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2010-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "UT",
            "license": "359724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DESERET MUTUAL",
            "identifier": "659871",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDUCATORS MUTUAL",
            "identifier": "870636000VA1",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECT HEALTH",
            "identifier": "107009651102",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D2495",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in American Fork, UT

Sources for this page

Verify at the official NPI Registry.