Kurt O Bodily, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

322494-1205 Issued in UT

Practice address

1055 N 500 W Ste 100
Provo, UT 84604-3305

Phone

(801) 374-1268

Fax

(801) 812-5454

NPI assigned

Jul 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Electronic endpoints 1

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

Specialty

Gastroenterology

Education

Washington University School of Medicine, 1990

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)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kurtbodily@cuccu.allscriptsdirect.net

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.

• Revere Health PC

  dba Revere Health

  • Multi-Specialty Clinic/Center
  • Provo, UT
  • NPI 1093764805
  Medicare reassignment Care Compare group NPD
• Revere Health PC

  dba Revere Health

  • Multi-Specialty Clinic/Center
  • Spanish Fork, UT
  • NPI 1851142285
  NPD

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1780600312",
    "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 100",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-374-1268",
            "fax_number": "801-812-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODILY",
        "first_name": "KURT",
        "middle_name": "O",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "UT",
            "license": "322494-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO",
            "identifier": "100009090",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "265465",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMIA",
            "identifier": "870281028BO2",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "39508",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS",
            "identifier": "QM0000009163",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHC",
            "identifier": "107007621101",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "29-00038",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Central Utah Clinic, P.C.",
            "address_1": "1055 N 500 W Ste 100",
            "city": "Provo",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846043305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• McKenley Boam, ATC
• Kaycee Bodell
• Jeremy Boden, MS
• Meagan Boden
• Darcy Bodily, RCS, CCT
• Martha Mogene Bodily, RN
• Kelcee Boehmer
• Hailey Boggess
• Victoria Boggs, PA
• Serena B. Bohn

• Gastroenterology Physician in Provo, UT
• Providers in Provo, UT by specialty
• Gastroenterology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.