NPIMap

Organization Active NPI

Utah Pain & Rehab LLC

  • Nurse Practitioner
  • Ogden, UT
National Provider Identifier
1689788762
Registry record updated Mar 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
347196-4405 Issued in UT
Legal business name
UTAH PAIN & REHAB LLC
Practice address
1276 Wall Ave Ste 1
Ogden, UT 84404-5673
Phone
(801) 337-4000
Fax
(801) 337-4002
NPI assigned
Aug 18, 2006
Last updated
Mar 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2025

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

Authorized official

Name
Shery Marchese
Title
Administrator
Phone
(801) 337-4000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 347196-4405 UT Primary
Adult Health Nurse Practitioner 363LA2200X NU
Clinical Social Worker 1041C0700X NU

Addresses

Primary practice location

1276 Wall Ave Ste 1
Ogden, UT 84404-5673

Mailing address

1276 Wall Ave Ste 1
Ogden, UT 84404-5673
Phone (801) 337-4000

Other names 1

  • Utah Pain and Rehab INC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031215000727 UT Part B Supplier - Clinic/Group Practice 5799682134 Receives reassigned benefits from 10 practitioners
Practice locations: Ogden, UT
O20250718002974 UT Part B Supplier - Clinic/Group Practice 4284140088 Receives reassigned benefits from 6 practitioners
Practice locations: Ogden, UT

National Provider Directory

National Provider Directory

Locations

1276 Wall Ave
Ste 1
Ogden, UT 84404
Phone (801) 337-4000

270 12th St
#B
Ogden, UT 84404
Phone (801) 337-4000

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742860800000",
    "number": "1689788762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1276 WALL AVE STE 1",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844045673",
            "telephone_number": "801-337-4000",
            "fax_number": "801-337-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1276 WALL AVE STE 1",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844045673",
            "telephone_number": "801-337-4000",
            "fax_number": "801-337-4002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UTAH PAIN & REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A",
        "authorized_official_last_name": "MARCHESE",
        "authorized_official_first_name": "SHERY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "801-337-4000"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "347196-4405",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Utah Pain and Rehab INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Ogden, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.