Active NPI
Brent S. Child, M.D.
- Anesthesiology Physician
- Salt Lake City, UT
National Provider Identifier
1689683823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 163630-1205
- Practice address
- 8TH Avenue and C Street
LDS Hospital
Salt Lake City, UT 84143 - Phone
- (801) 507-5248
- Fax
- (801) 733-5618
- NPI assigned
- Aug 5, 2006
- Last updated
- Oct 15, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 79-163630-1205 | UT | |
| Anesthesiology Physician | 207L00000X | 163630-1205 | UT | Primary |
Addresses
Primary practice location
8TH Avenue and C Street
LDS Hospital
Salt Lake City, UT 84143
Mailing address
3340 North Center St #800
Lehi, UT 84043-7406
Phone (801) 990-1911
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8597445 | Other | UT | WORKERS COMP FUND |
| 870545614CH2 | Other | UT | EDUCATORS MUTUAL |
| PRA05761 | Other | UT | MOLINA |
| 110169200 | Medicaid | WY | |
| 2090168 | Other | UT | UNITED HEALTHCARE |
| 003619600 | Medicaid | ID | |
| 1502954 | Other | UT | UMWA |
| 288177 | Medicaid | AZ | |
| 37777 | Other | UT | PEHP |
| QM0000075886 | Other | UT | ALTIUS |
| 3252 | Other | UT | HEALTHY U |
| 002082843 | Medicaid | NV | |
| 107005371101 | Other | UT | IHC |
| 36621 | Other | UT | DESERET MUTUAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 79-163630-1205 | UT | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jon Q Ward, MD, PC | Anesthesiology | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Anesthesiology Physician
- Salt Lake City, UT
- NPI 1831374966
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350259200000",
"number": "1689683823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3340 NORTH CENTER ST #800",
"city": "LEHI",
"state": "UT",
"postal_code": "840437406",
"telephone_number": "801-990-1911",
"fax_number": "801-990-1912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8TH AVENUE AND C STREET",
"address_2": "LDS HOSPITAL",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "84143",
"telephone_number": "801-507-5248",
"fax_number": "801-733-5618"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHILD",
"first_name": "BRENT",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-05",
"last_updated": "2012-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "UT",
"license": "79-163630-1205",
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "UT",
"license": "163630-1205",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WORKERS COMP FUND",
"identifier": "8597445",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EDUCATORS MUTUAL",
"identifier": "870545614CH2",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOLINA",
"identifier": "PRA05761",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110169200",
"state": "WY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "2090168",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003619600",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UMWA",
"identifier": "1502954",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "288177",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEHP",
"identifier": "37777",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALTIUS",
"identifier": "QM0000075886",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHY U",
"identifier": "3252",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002082843",
"state": "NV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IHC",
"identifier": "107005371101",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DESERET MUTUAL",
"identifier": "36621",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.