NPIMap

Organization Active NPI

Jordan Ridge Family Medicine LLC

  • Family Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1770509754
Registry record updated Jul 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
JORDAN RIDGE FAMILY MEDICINE LLC
Practice address
6321 S Redwood Rd
Ste 201
Salt Lake City, UT 84123-6798
Phone
(801) 265-2212
Fax
(801) 265-0103
NPI assigned
Jul 14, 2006
Last updated
Jul 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2023

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

Authorized official

Name
Mrs. Emily D Castillo
Title
Medical Staff Manager
Phone
(702) 480-2550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

6321 S Redwood Rd
Ste 201
Salt Lake City, UT 84123-6798

Mailing address

6321 S Redwood Rd
Suite 201
Salt Lake City, UT 84123-6798
Phone (801) 265-2212

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060821000255 UT Part B Supplier - Clinic/Group Practice 8820091473 Receives reassigned benefits from 31 practitioners
2 other NPIs on this enrollment
Practice locations: West Valley City, UT; Taylorsville, UT; Sandy, UT; Layton, UT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

557 W 2600 S
Bountiful, UT 84010
Phone (801) 296-5805

1580 W Antelope Dr
Layton, UT 84041
Phone (801) 773-4770

1580 W Antelope Dr
Ste 250
Layton, UT 84041
Phone (801) 773-4770

2146 N Main St
Ste 514
Layton, UT 84041

1403 E Sego Lily Dr
Sandy, UT 84092
Phone (801) 316-9620

1403 E Sego Lily Dr
#100B
Sandy, UT 84092

4071 S 4000 W
Ste 1B
West Valley, UT 84120

Practitioners & affiliated clinicians

Practitioners 37

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.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690761600000",
    "number": "1770509754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6321 S REDWOOD RD",
            "address_2": "SUITE 201",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841236798",
            "telephone_number": "801-265-2212",
            "fax_number": "801-265-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6321 S REDWOOD RD",
            "address_2": "STE 201",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841236798",
            "telephone_number": "801-265-2212",
            "fax_number": "801-265-0103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORDAN RIDGE FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "EMILY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL STAFF MANAGER",
        "authorized_official_telephone_number": "702-480-2550",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "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 Jul 31, 2023; 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.