NPIMap

Organization Active NPI

Premier Provider Health Utah PLLC

Doing business as Wound Integrity Utah

  • Internal Medicine Physician
  • Ogden, UT
National Provider Identifier
1699311209
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PREMIER PROVIDER HEALTH UTAH PLLC
Doing business as
Wound Integrity Utah
Practice address
5475 S 500 E
Ogden, UT 84405-6905
Phone
(801) 479-2111
NPI assigned
Nov 19, 2019
Last updated
Nov 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Authorized official

Name
Nora Lopez
Title
Authorized Official
Phone
(346) 239-9469

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
Infectious Disease Physician 207RI0200X NU

Addresses

Primary practice location

5475 S 500 E
Ogden, UT 84405-6905

Mailing address

1 Chisholm Trail Rd Ste 5200
Round Rock, TX 78681-5090
Phone (512) 202-3830

Other names 1

  • Wound Integrity Utah Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200413000010 UT Part B Supplier - Clinic/Group Practice 0042649113 Receives reassigned benefits from 7 practitioners
Practice locations: Ogden, UT

National Provider Directory

National Provider Directory

Locations

1 Chisholm Trail Rd
Ste 5200
Round Rock, TX 78681
Phone (346) 239-9469

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731456000000",
    "number": "1699311209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHISHOLM TRAIL RD STE 5200",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786815090",
            "telephone_number": "512-202-3830",
            "fax_number": "512-354-1106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5475 S 500 E",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844056905",
            "telephone_number": "801-479-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PROVIDER HEALTH UTAH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-19",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "NORA",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "346-239-9469"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wound Integrity Utah",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 13, 2024; 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.