Cedar Ridge Family Medicine
Organization Active NPI Family Medicine Physician · Cedar City, UT
NPI 1740260504 · NPPES record last updated Oct 11, 2024
Key facts
- NPI
- 1740260504
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 50914131205 (UT)
- Legal business name
- CEDAR RIDGE FAMILY MEDICINE
- Practice address
- 110 West 1325 North
#200
Cedar City, UT 84720 - Phone
- (435) 586-7676
- Fax
- (435) 586-2290
- NPI assigned
- Jan 18, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- CEDAR RIDGE FAMILY MEDICINE
Authorized official
- Name
- Steven R Newman, MD
- Title
- Owner
- Phone
- (435) 586-7676
Practitioners 19
-
Michael Brent Bulloch, D.O.
-
Garrett Ray Galt, FNP-C
-
Kyle William Randall, CNP
-
Jessica Barney, PA
-
Jason Karl North, D.O,
-
Patrick Thompson, PA-C
-
Jarid D Gray, M.D.
-
Ryan Lee Emmett, D.C.
-
Michael R Taylor, D.C.
-
Julie A Wilcken, MPAS
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050128000118 | UT | Part B Supplier - Clinic/Group Practice | 3971553884 |
Receives reassigned benefits from 18 practitioners Practice locations: Cedar City, UT |
National Provider Directory
- Part of
- Gray Family Medicine
Locations
1760 N Main St
Ste 106B
Cedar City, UT 84721
Phone (435) 586-7676
445 E 3000 N
Ste 130
Cedar City, UT 84721
Phone (435) 586-7676
3401 N Thanksgiving Way
Lehi, UT 84048
Interoperability endpoints
- https://api.platform.athenahealth.com/22054/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 50914131205 | UT | Yes |
| Urgent Care Clinic/Center | 261QU0200X |
Addresses
Primary practice location
110 West 1325 North
#200
Cedar City, UT 84720
Mailing address
110 West 1325 North
#200
Cedar City, UT 84720
Phone (435) 586-7676
Other practice location 1
445 E 3000 N
Suite 130
Cedar City, UT 84721
Phone (435) 586-7676
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 529727490005 | Medicaid | UT |
Other names
- Gray Family Medicine
- Cedar Ridge Urgent Care
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | frontdesk@cedarridgefammed.com | Direct |
Other providers in Cedar City, UT
- Cedar Drug and Gift, Inc
- Cedar Drug and Gift, Inc
- Cedar Ophthalmic Associates PLLC
- Cedar Orthopaedic Bone Densitometry
- Cedar Orthopaedic Surgery Center, LLC
- Cedar Skilled Nursing Facility LLC
- Cedar Smiles LLC
- Cedar Surgical Associates LC
- Cedar View Counseling LLC
- Cedar View Pediatric Denitstry
All providers in Cedar City, UT · Family Medicine Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.