Individual provider Active NPI

Michael Max Adam, MD

  • Vascular & Interventional Radiology Physician
  • Provo, UT
National Provider Identifier
1740608272
Registry record updated Apr 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
11685099-1205 Issued in UT
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, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200508000907 UT Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 2466883343 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional RadiologyAlso: Diagnostic Radiology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Revere Health PCGroup PAC ID 7517868508, 407 clinicians

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

LicenseStateTypeSpecialty
2019009760MOMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Revere Health PC CurrentSince Jun 29, 2020 Accepting new patients
Revere Health PC CurrentSince Jun 29, 2020 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

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.