Organization Active NPI

Savannah Health Group LLC

  • Gerontology Nurse Practitioner
  • Salt Lake City, UT
National Provider Identifier
1750875183
Registry record updated Oct 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
Legal business name
SAVANNAH HEALTH GROUP LLC
Practice address
4035 S 500 E
Salt Lake City, UT 84107-1866
Phone
(801) 262-9181
Fax
(813) 336-8463
NPI assigned
Jun 19, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2020

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

Authorized official

Name
Edwin O Awinda, APRNNPI 1194216895
Title
Sole Member
Phone
(801) 941-4034

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Gerontology Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LG0600X Primary

Addresses

Primary practice location

4035 S 500 E
Salt Lake City, UT 84107-1866

Mailing address

1728 S Wright CT
Salt Lake City, UT 84105-2914
Phone (801) 941-4034

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180821003404 UT Part B Supplier - Clinic/Group Practice 6103175393 Receives reassigned benefits from 1 practitioner
Practice locations: Salt Lake City, UT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1529366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601596800000",
    "number": "1750875183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1728 S WRIGHT CT",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841052914",
            "telephone_number": "801-941-4034",
            "fax_number": "813-336-8463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4035 S 500 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841071866",
            "telephone_number": "801-262-9181",
            "fax_number": "813-336-8463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAVANNAH HEALTH GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-19",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A",
        "authorized_official_last_name": "AWINDA",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "801-941-4034",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; 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.