Gary L Halversen, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

1619861205 Issued in UT

Practice address

1151 E 3900 S
#B150
Salt Lake City, UT 84124-1216

Phone

(801) 262-3441

Fax

(801) 269-9005

NPI assigned

Jun 22, 2005

Last updated

Sep 30, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Revere Health PC

  dba Revere Health

  • Multi-Specialty Clinic/Center
  • Spanish Fork, UT
  • NPI 1851142285
  NPD (past)

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380499200000",
    "number": "1740286970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 E 3900 S",
            "address_2": "#B150",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241216",
            "telephone_number": "801-262-3441",
            "fax_number": "801-269-9005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 E 3900 S",
            "address_2": "#B150",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241216",
            "telephone_number": "801-262-3441",
            "fax_number": "801-269-9005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALVERSEN",
        "first_name": "GARY",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2013-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "1619861205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Bryan Halliwill
• William Halls, MD
• Angela Hallstrom, PT
• Camille Hally
• Abby E. Halm, MD
• Julia Halvorson-Phelan, MD
• Lily Halvorson
• Ahmad Sami Halwani, M.D.
• Erinn Hama, MD
• Lester Craig Hamada, RPH

• Diagnostic Radiology Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Diagnostic Radiology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2013; 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.