Active NPI
Michael Max Adam, MD
- Vascular & Interventional Radiology Physician
- Provo, UT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular & Interventional Radiology Physician
- License
- 11685099-1205
- Practice address
- 1055 N 500 W Ste 112
Provo, UT 84604-3305 - Phone
- (801) 812-4624
- Fax
- (801) 812-4699
- NPI assigned
- Apr 2, 2014
- Last updated
- Apr 20, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular & Interventional Radiology Physician | 2085R0204X | 2019009760 | MO | |
| Vascular & Interventional Radiology Physician | 2085R0204X | 11685099-1205 | UT | Primary |
Addresses
Primary practice location
1055 N 500 W Ste 112
Provo, UT 84604-3305
Mailing address
1055 N 500 W
Attn: Credentialing
Provo, UT 84604-3305
Phone (801) 354-8225
Other practice location 1
555 W Sr 164
Salem, UT 84653
Phone (801) 812-4624
Other practice location 2
3000 N Triumph Blvd Ste 100
Lehi, UT 84043-4999
Phone (801) 812-4624
Other practice location 3
1175 E 50 S Ste 141
American Fork, UT 84003-2845
Phone (801) 812-4624
Other practice location 4
2825 E Mall Dr
St George, UT 84790-1954
Phone (435) 986-2238
Other practice location 5
30 N 1900 E
Room 4C104
Salt Lake City, UT 84132-0002
Phone (801) 581-7606
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Interventional Radiology
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1055 N 500
Provo, UT 84604-3305
Phone (801) 812-4624
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019009760 | MO | MD | Vascular & Interventional Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revere Health PC | Current | Accepting new patients | |
| Revere Health PC | Current | Accepting new patients |
Locations
1175 E 50 S
Ste 141
American Fork, UT 84003
Phone (801) 492-5996
3000 N Triumph Blvd
Ste 100
Lehi, UT 84043
Phone (385) 345-3155
1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000
1055 N 500 W
Ste 112
Provo, UT 84604
Phone (801) 812-4624
1055 N 500 W
Ste 212
Provo, UT 84604
Phone (801) 374-2362
555 W State Road 164
Salem, UT 84653
Phone (801) 465-4896
2825 E Mall Dr
St George, UT 84790
Phone (435) 673-6131
Interoperability endpoints
- michaeladam@cuccu.allscriptsdirect.net
Organizations & group practices 2
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.
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Holy Cross Hospital - Jordan Valley
- General Acute Care Hospital
- West Jordan, UT
- NPI 1801591391
-
- Critical Access Hospital
- Nephi, UT
- NPI 1881658110
-
dba Nephi Medical Clinic
- Family Medicine Physician
- Nephi, UT
- NPI 1992724975
Hospital
-
dba Mountain View Hospital
- General Acute Care Hospital
- Payson, UT
- NPI 1487607669
-
dba Timpanogos Regional Hospital
- General Acute Care Hospital
- Orem, UT
- NPI 1497702195
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1396396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776643200000",
"number": "1740608272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 N 500 W",
"address_2": "ATTN: CREDENTIALING",
"city": "PROVO",
"state": "UT",
"postal_code": "846043305",
"telephone_number": "801-354-8225",
"fax_number": "801-418-0941"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1055 N 500 W STE 112",
"city": "PROVO",
"state": "UT",
"postal_code": "846043305",
"telephone_number": "801-812-4624",
"fax_number": "801-812-4699"
}
],
"practiceLocations": [
{
"address_1": "555 W SR 164",
"address_purpose": "LOCATION",
"city": "Salem",
"state": "UT",
"postal_code": "84653",
"country_code": "US",
"telephone_number": "801-812-4624",
"fax_number": "801-812-4699",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3000 N Triumph Blvd Ste 100",
"address_purpose": "LOCATION",
"city": "Lehi",
"state": "UT",
"postal_code": "840434999",
"country_code": "US",
"telephone_number": "801-812-4624",
"fax_number": "801-812-4699",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1175 E 50 S Ste 141",
"address_purpose": "LOCATION",
"city": "American Fork",
"state": "UT",
"postal_code": "840032845",
"country_code": "US",
"telephone_number": "801-812-4624",
"fax_number": "801-812-4699",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2825 E Mall Dr",
"address_purpose": "LOCATION",
"city": "St George",
"state": "UT",
"postal_code": "847901954",
"country_code": "US",
"telephone_number": "435-986-2238",
"fax_number": "435-986-2237",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "30 N 1900 E",
"address_2": "Room 4C104",
"address_purpose": "LOCATION",
"city": "Salt Lake City",
"state": "UT",
"postal_code": "841320002",
"country_code": "US",
"telephone_number": "801-581-7606",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ADAM",
"first_name": "MICHAEL",
"middle_name": "MAX",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-04-02",
"last_updated": "2026-04-20",
"certification_date": "2026-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "MO",
"license": "2019009760",
"primary": false
},
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "UT",
"license": "11685099-1205",
"primary": true
}
],
"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 Apr 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.