NPIMap

Organization Active NPI

Vernon Medical PLLC

Doing business as Alder Grove Pediatrics

  • Pediatrics Physician
  • Logan, UT
National Provider Identifier
1699238436
Registry record updated Apr 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
VERNON MEDICAL PLLC
Doing business as
Alder Grove Pediatrics
Practice address
630 E 1400 N Ste 118
Logan, UT 84341-2691
Phone
(435) 799-7953
Fax
(435) 514-7977
NPI assigned
Apr 9, 2019
Last updated
Apr 9, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
VERNON MEDICAL PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 9, 2019

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

Authorized official

Name
Brian A Vernon, MDNPI 1265639280
Title
Owner
Phone
(435) 799-7953

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

630 E 1400 N Ste 118
Logan, UT 84341-2691

Mailing address

630 E 1400 N Ste 118
Logan, UT 84341-2691
Phone (435) 799-7953

Other names 1

  • Alder Grove Pediatrics Doing business as

National Provider Directory

National Provider Directory
Part of
Vernon Medical PLLC

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554768000000",
    "number": "1699238436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 E 1400 N STE 118",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412691",
            "telephone_number": "435-799-7953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 E 1400 N STE 118",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412691",
            "telephone_number": "435-799-7953",
            "fax_number": "435-514-7977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VERNON MEDICAL PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VERNON MEDICAL PLLC",
        "enumeration_date": "2019-04-09",
        "last_updated": "2019-04-09",
        "status": "A",
        "authorized_official_last_name": "VERNON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-799-7953",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alder Grove Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Logan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.