NPIMap

Organization Active NPI

Pediatric PM and R

  • Pediatric Rehabilitation Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1760776223
Registry record updated Jun 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Rehabilitation Medicine PhysicianTaxonomy code 2081P0010X
License
72775361205 Issued in UT
Legal business name
PEDIATRIC PM AND R
Practice address
100 Mario Capecchi Dr
Room 4400
Salt Lake City, UT 84113-1103
Phone
(801) 662-4949
Fax
(801) 662-4931
NPI assigned
Jun 1, 2011
Last updated
Jun 1, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2011

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

Authorized official

Name
Dr. Elie P Elovic, MD
Title
Chair
Phone
(801) 662-4949

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 72775361205 UT
Pediatric Rehabilitation Medicine Physician 2081P0010X 72775361205 UT Primary

Addresses

Primary practice location

100 Mario Capecchi Dr
Room 4400
Salt Lake City, UT 84113-1103

Mailing address

PO Box 413032
Salt Lake City, UT 84141-3032
Phone (801) 213-3900

National Provider Directory

National Provider Directory

Locations

100 N Mario Capecchi Dr
Rm 4400
Salt Lake City, UT 84113
Phone (801) 662-4949

Practitioners & affiliated clinicians

Practitioners 7

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": "1306886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306886400000",
    "number": "1760776223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 413032",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841413032",
            "telephone_number": "801-213-3900",
            "fax_number": "801-585-3655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MARIO CAPECCHI DR",
            "address_2": "ROOM 4400",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-662-4949",
            "fax_number": "801-662-4931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PM AND R",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-01",
        "last_updated": "2011-06-01",
        "status": "A",
        "authorized_official_last_name": "ELOVIC",
        "authorized_official_first_name": "ELIE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHAIR",
        "authorized_official_telephone_number": "801-662-4949",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "UT",
            "license": "72775361205",
            "primary": false
        },
        {
            "code": "2081P0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
            "state": "UT",
            "license": "72775361205",
            "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 Jun 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.