NPIMap

Organization Active NPI

Blue Rock Neurological LLC

  • Neurology Physician
  • Provo, UT
National Provider Identifier
1730554734
Registry record updated Dec 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
BLUE ROCK NEUROLOGICAL LLC
Practice address
3152 N University Ave Ste 220
Provo, UT 84604-4746
Phone
(801) 229-1014
Fax
(801) 229-1067
NPI assigned
Dec 2, 2015
Last updated
Dec 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2015

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

Authorized official

Name
Wendell Gibby, MDNPI 1992802235
Title
Manager/Owner
Phone
(801) 229-1014

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X UT
Family Nurse Practitioner 363LF0000X UT
Addiction Medicine (Family Medicine) Physician 207QA0401X UT
Neurology Physician 2084N0400X UT Primary
Interventional Pain Medicine Physician 208VP0014X UT

Addresses

Primary practice location

3152 N University Ave Ste 220
Provo, UT 84604-4746

Mailing address

3152 N University Ave Ste 220
Provo, UT 84604-4746
Phone (801) 229-1014

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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": "1449014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449014400000",
    "number": "1730554734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3152 N UNIVERSITY AVE STE 220",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044746",
            "telephone_number": "801-229-1014",
            "fax_number": "801-229-1067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3152 N UNIVERSITY AVE STE 220",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044746",
            "telephone_number": "801-229-1014",
            "fax_number": "801-229-1067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE ROCK NEUROLOGICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-02",
        "last_updated": "2015-12-02",
        "status": "A",
        "authorized_official_last_name": "GIBBY",
        "authorized_official_first_name": "WENDELL",
        "authorized_official_title_or_position": "MANAGER/OWNER",
        "authorized_official_telephone_number": "801-229-1014",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "UT",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "UT",
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "UT",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2015; 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.