NPIMap

Organization Active NPI

Ashley Valley Physician Practice, LLC

Doing business as Petar M. Ilievski, MD

  • Urology Physician
  • Vernal, UT
National Provider Identifier
1740423367
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
7161419-8017 Issued in UT
Legal business name
ASHLEY VALLEY PHYSICIAN PRACTICE, LLC
Doing business as
Petar M. Ilievski, MD
Practice address
150 W 100 N
Vernal, UT 84078-2036
Phone
(435) 381-4511
NPI assigned
Apr 13, 2009
Last updated
Sep 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Authorized official

Name
Charlotte Lawrence
Title
Secretary
Phone
(615) 920-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X 7161419-8017 UT Primary

Addresses

Primary practice location

150 W 100 N
Vernal, UT 84078-2036

Mailing address

150 W 100 N
Vernal, UT 84078-2036
Phone (435) 381-4511

Other names 1

  • Petar M. Ilievski, MD Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050119001166 UT Part B Supplier - Clinic/Group Practice 4284683947 Receives reassigned benefits from 57 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vernal, UT; Roosevelt, UT; Price, UT

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

150 W 100 N
Ste 102S
Vernal, UT 84078
Phone (435) 781-2161

Practitioners & affiliated clinicians

Practitioners 8

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": "1239580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1740423367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 W 100 N",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "840782036",
            "telephone_number": "435-381-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 W 100 N",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "840782036",
            "telephone_number": "435-381-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASHLEY VALLEY PHYSICIAN PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-13",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "UT",
            "license": "7161419-8017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Petar M. Ilievski, MD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Petar M. Ilievski, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vernal, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.