NPIMap

Individual provider Active NPI

Bradley J. Waterman, MD

  • Urology Physician
  • Salt Lake City, UT
National Provider Identifier
1699718809
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
6602968-1205 Issued in UT
Practice address
24 S 1100 E Ste 105
Salt Lake City, UT 84102-1593
Phone
(801) 965-3600
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 46318 WI
Urology Physician 208800000X 6602968-1205 UT Primary

Addresses

Primary practice location

24 S 1100 E Ste 105
Salt Lake City, UT 84102-1593

Mailing address

2965 W 3500 S
West Valley City, UT 84119-3602
Phone (801) 965-3600

Other practice location 1

1060 E 100 S
Suite 110
Salt Lake City, UT 84102-1501
Phone (801) 531-9453

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070808000277 UT Practitioner - Urology 9436240298 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Utah School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Granger Medical Clinic PCGroup PAC ID 3476465691, 192 clinicians

Practice addresses (Care Compare)

2965 W 3500
West Valley City, UT 84119-3602
Phone (801) 965-3600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection24

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
6602968-1205UTMDUrology Physician
46318WIMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Granger Medical Clinic PC Current Accepting new patients
Granger Medical Clinic PC CurrentSince Dec 27, 2023 Accepting new patients
Granger Medical Specialists, LLC CurrentSince Nov 1, 2020 Accepting new patients
Granger Medical Specialists LLC CurrentSince Nov 1, 2020 Accepting new patients
Cardiovascular Care Providers, Inc. Past Accepting new patients
Houston Northwest Radiology Assn PastSince Mar 13, 2022 Accepting new patients
Granger Medical Clinic PC PastSince Apr 1, 2016 Accepting new patients

Locations

12391 S 4000 W
Riverton, UT 84096
Phone (801) 302-1700

995 W Levoy Dr
Taylorsville, UT 84123

7181 S Campus View Dr
Ste 200
West Jordan, UT 84084
Phone (801) 965-3505

7181 S Campus View Dr
West Jordan, UT 84084
Phone (801) 965-3505

3725 W 4100 S
West Valley City, UT 84120
Phone (801) 965-3545

2965 W 3500 S
West Valley City, UT 84119
Phone (801) 965-3505

Interoperability endpoints

  • Direct secure messaging: bradley.waterman@gmcwv.eclinicaldirectplus.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1699718809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2965 W 3500 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841193602",
            "telephone_number": "801-965-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 S 1100 E STE 105",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021593",
            "telephone_number": "801-965-3600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1060 E 100 S",
            "address_2": "Suite 110",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841021501",
            "country_code": "US",
            "telephone_number": "801-531-9453",
            "fax_number": "801-531-9467",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATERMAN",
        "first_name": "BRADLEY",
        "middle_name": "J.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WI",
            "license": "46318",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "UT",
            "license": "6602968-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.