Individual provider Active NPI

Rodolfo G Madlang, MD

  • Anesthesiology Physician
  • Ogden, UT
National Provider Identifier
1710071139
Registry record updated Oct 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
82-169053-1205 Issued in UT
Practice address
4401 Harrison Boulevard
McKay Dee Hospital
Ogden, UT 84403
Phone
(801) 507-5248
Fax
(801) 733-5618
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 82-169053-1205 UT Primary

Addresses

Primary practice location

4401 Harrison Boulevard
McKay Dee Hospital
Ogden, UT 84403

Mailing address

3340 North Center St #800
Lehi, UT 84043-7406
Phone (801) 990-1911

Other identifiers 14

IdentifierTypeStateIssuer
1502954OtherUTUMWA
2090168OtherUTUNITED HEALTHCARE
804070100MedicaidID
870545614MA1OtherUTEDUCATORS MUTUAL
100501221MedicaidNV
110961800MedicaidWY
PRA04118OtherUTMOLINA
QM0000075886OtherUTALTIUS
107005082102OtherUTIHC
820953MedicaidAZ
36507OtherUTDESERET MUTUAL
37803OtherUTPEHP
53253OtherUTHEALTHY U
8597445OtherUTWORKERS COMP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090807000286 UT Practitioner - Anesthesiology 3072666072 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
82-169053-1205UTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain West Anesthesia LLC Anesthesiology CurrentSince Apr 21, 2016 Accepting new patients

Locations

3340 N Center St
Ste 800
Lehi, UT 84043
Phone (800) 501-4788

10150 S Centennial Pkwy
Ste 230
Sandy, UT 84070
Phone (425) 284-1545

150 W Civic Center Dr
Ste 200
Sandy, UT 84070
Phone (801) 727-2056

4401 Harrison Blvd
South Ogden, UT 84403
Phone (801) 387-2800

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350259200000",
    "number": "1710071139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 NORTH CENTER ST #800",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840437406",
            "telephone_number": "801-990-1911",
            "fax_number": "801-990-1912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 HARRISON BOULEVARD",
            "address_2": "MCKAY DEE HOSPITAL",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "84403",
            "telephone_number": "801-507-5248",
            "fax_number": "801-733-5618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADLANG",
        "first_name": "RODOLFO",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2012-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "82-169053-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "1502954",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2090168",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804070100",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDUCATORS MUTUAL",
            "identifier": "870545614MA1",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100501221",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110961800",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA",
            "identifier": "PRA04118",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS",
            "identifier": "QM0000075886",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHC",
            "identifier": "107005082102",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "820953",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DESERET MUTUAL",
            "identifier": "36507",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "37803",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY U",
            "identifier": "53253",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMP",
            "identifier": "8597445",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

Verify at the official NPI Registry.