NPIMap

Individual provider Active NPI

Ivan Rodrigo Zendejas Ruiz, MD

  • Surgery Physician
  • Murray, UT
National Provider Identifier
1760542054
Registry record updated Jun 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
9580790-1205 Issued in UT
Practice address
5171 S Cottonwood St
Ste 650
Murray, UT 84107-5716
Phone
(352) 265-0606
Fax
(352) 265-0678
NPI assigned
Dec 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Transplant Surgery Physician 204F00000X 10757 FL
Surgery Physician 208600000X ME108537 FL
Surgery Physician 208600000X 9580790-1205 UT Primary

Addresses

Primary practice location

5171 S Cottonwood St
Ste 650
Murray, UT 84107-5716

Mailing address

5171 S Cottonwood St
Ste 650
Murray, UT 84107-5716
Phone (352) 265-0606

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160229001388 UT Practitioner - General Surgery 3476741851 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Canyon Surgical Associates, LLCGroup PAC ID 3779580774, 5 clinicians

Practice addresses (Care Compare)

5171 S Cottonwood St
Suite 650
Murray, UT 84107-5716
Phone (801) 507-9600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME108537FLMDDiagnostic Radiology Physician
10757FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc CurrentSince May 23, 2016 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

5121 S Cottonwood St
Salt Lake Cty, UT 84107
Phone (801) 408-8998

Organizations & group practices 4

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

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": "1165622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467158400000",
    "number": "1760542054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5171 S COTTONWOOD ST",
            "address_2": "STE 650",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075716",
            "telephone_number": "352-265-0606",
            "fax_number": "352-265-0678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5171 S COTTONWOOD ST",
            "address_2": "STE 650",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075716",
            "telephone_number": "352-265-0606",
            "fax_number": "352-265-0678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZENDEJAS RUIZ",
        "first_name": "IVAN",
        "middle_name": "RODRIGO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-09",
        "last_updated": "2016-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204F00000X",
            "taxonomy_group": "",
            "desc": "Transplant Surgery",
            "state": "FL",
            "license": "10757",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME108537",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "UT",
            "license": "9580790-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

Verify at the official NPI Registry.