Pine Top Medical P.C.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

93369771204 Issued in UT

Legal business name

PINE TOP MEDICAL P.C.

Practice address

284 N Hospital Dr
Suite 2
Price, UT 84501-4233

Phone

(435) 637-5690

Fax

(435) 637-9809

NPI assigned

Jun 29, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Eugene Douglas Larsen Jr., D.O.NPI 1447513221

Title

President

Phone

(801) 309-5156

Specialties & licenses 1

Addresses

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.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HGCCDA

Practitioners 2

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

• Eugene Douglas Larsen Jr., DO

  • Internal Medicine Physician
  • Price, UT
  • NPI 1447513221

  UT

  Medicare reassignment NPD Authorized official
• David Alan Nichols, MD

  • Internal Medicine Physician
  • Provo, UT
  • NPI 1902893993
  NPD (past)

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

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439164800000",
    "number": "1679956445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "284 N HOSPITAL DR",
            "address_2": "SUITE 2",
            "city": "PRICE",
            "state": "UT",
            "postal_code": "845014233",
            "telephone_number": "435-637-5690",
            "fax_number": "435-637-9809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "284 N HOSPITAL DR",
            "address_2": "SUITE 2",
            "city": "PRICE",
            "state": "UT",
            "postal_code": "845014233",
            "telephone_number": "435-637-5690",
            "fax_number": "435-637-9809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE TOP MEDICAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-29",
        "last_updated": "2015-08-10",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-309-5156",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "UT",
            "license": "93369771204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Peet, RN
• Lacey Pell, RN
• Danielle Howa Pendergrass, DNP, APRN, WHNP-BC
• Gloria Pendleton
• Douglas Wilford Perkins, D.O.
• Pinnacle Anesthesia Associates, LLC
• Pinnacle Psychiatry & Behavioral Health PLLC
• Donald Ray Polster, RPH
• Justin Pope, O.T
• Brittnay Popejoy

• All providers in Price, UT
• Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2015; 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.