NPIMap

Individual provider Active NPI

Stuart Eliot Willick, MD

  • Physical Medicine & Rehabilitation Physician
  • Park City, UT
National Provider Identifier
1720169915
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
371707-1205 Issued in UT
Practice address
1493 Lowell Ave
Park City, UT 84060
Phone
(435) 655-7970
NPI assigned
Oct 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 371707-1205 UT
Physical Medicine & Rehabilitation Physician 208100000X 371707-1205 UT Primary

Addresses

Primary practice location

1493 Lowell Ave
Park City, UT 84060

Mailing address

PO Box 58108
Salt Lake City, UT 84158-0108
Phone (801) 581-3998

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address swillick23255@direct.med.utah.edu Direct UNIVERSITY OF UTAH

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
I20040903000475 UT Practitioner - Sports Medicine 3870569577 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sports Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

50 N Medical Dr
University of Utah Hospital Pmandr
Salt Lake City, UT 84132-0100
Phone (801) 587-6336

9385 S Snowbird Ctr Dr
Sandy, UT 84092-6249
Phone (801) 646-4800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.61 of 100Reported as group
Quality
93.24
Promoting interoperability
100
Improvement activities
40
Cost
45.48

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
371707-1205UTMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Specialty Services CurrentSince Feb 1, 2015 Accepting new patients
University of Utah Adult Services CurrentSince Feb 20, 2021 Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Specialty Services CurrentSince Feb 1, 2015 Accepting new patients
University of Utah Specialty Services Current Accepting new patients
University of Utah Adult Services CurrentSince Feb 20, 2021 Accepting new patients
University of Utah Specialty Services Past Accepting new patients
University of Utah Specialty Services Past Accepting new patients

Locations

2001 Errecart Blvd
Elko, NV 89801
Phone (775) 738-5151

250 E 200 S
Ste 1350
Salt Lake City, UT 84111
Phone 80158763362003

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

590 S Wakara Way
Slc, UT 84108
Phone (801) 587-7005

9385 S Snowbird Center Dr
Snowbird, UT 84092
Phone (801) 587-7109

Interoperability endpoints

  • Direct secure messaging: swillick23255@direct.med.utah.edu

Organizations & group practices 8

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 3

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": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1720169915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 58108",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841580108",
            "telephone_number": "801-581-3998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1493 LOWELL AVE",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "84060",
            "telephone_number": "435-655-7970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLICK",
        "first_name": "STUART",
        "middle_name": "ELIOT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "UT",
            "license": "371707-1205",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "UT",
            "license": "371707-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "swillick23255@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "UNIVERSITY OF UTAH",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Park City, UT

Sources for this page

Verify at the official NPI Registry.