Premier Plastic Surgery Group of Utah

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

Legal business name

PREMIER PLASTIC SURGERY GROUP OF UTAH

Practice address

11762 S State St Ste 220
Draper, UT 84020-7156

Phone

(801) 571-2020

Fax

(801) 571-6899

NPI assigned

Feb 11, 2010

Organization subpart

No

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

Authorized official

Name

Stephanie White

Title

Secretary

Phone

(801) 571-2020

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Premier Plastic Surgery Group of Utah, L.L.C.

  • Specialist
  • Sandy, UT
  • NPI 1497941603

  O20040910000970

  Same enrollment
• Premier Plastic Surgery Group of Utah, LLC

  • Plastic Surgery Physician
  • Bountiful, UT
  • NPI 1851545081

  O20040910000970

  Same enrollment

Tax ID family

Premier Plastic Surgery Group of Utah2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Premier Plastic Surgery Group of Utah, L.L.C.

  • Specialist
  • Sandy, UT
  • NPI 1497941603
  NPD tax ID

Locations

Practitioners 5

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.

• Richard H Fryer, MD

  • Plastic Surgery Physician
  • Draper, UT
  • NPI 1760572366
  NPD
• Nicholas Kay Howland, M.D.

  • Plastic Surgery Physician
  • Draper, UT
  • NPI 1659666295
  NPD
• Dino Maglic, M.D.

  • Plastic Surgery Physician
  • Salt Lake City, UT
  • NPI 1639602790
  NPD
• Steven H. Warnock, M.D.

  • Specialist
  • Draper, UT
  • NPI 1457337594
  NPD
• Larry Givens Leonard, M.D.

  • Specialist
  • Bozeman, MT
  • NPI 1972523942
  NPD (past)

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

{
    "created_epoch": "1265846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295395200000",
    "number": "1689906976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11762 S STATE ST STE 220",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207156",
            "telephone_number": "801-571-2020",
            "fax_number": "801-571-6899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11762 S STATE ST STE 220",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207156",
            "telephone_number": "801-571-2020",
            "fax_number": "801-571-6899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PLASTIC SURGERY GROUP OF UTAH",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-11",
        "last_updated": "2011-01-19",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "801-571-2020"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528276851028",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529316986001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan E Prater, M.D.
• Amanda Miller Pratt, AU.D
• Lori Pratt
• Precision Therapy Inc.
• Premier Medical Distribution
• Bradley Prestwich, MD
• Cathleen Price
• Cordell Prince
• Tyler L Prince
• Private Healthcare Facilities (Beautiful Mountain Birth Suites)

• Plastic and Reconstructive Surgery Physician in Draper, UT
• Providers in Draper, UT by specialty
• Plastic and Reconstructive Surgery Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2011; 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.