NPIMap

Organization Active NPI

Paiute Indian Tribe of Utah

  • Federally Qualified Health Center (FQHC)
  • St George, UT
National Provider Identifier
1801063441
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PAIUTE INDIAN TRIBE OF UTAH
Practice address
1449 N 1400 W Ste 19
St George, UT 84770-5237
Phone
(354) 688-8199
Fax
(435) 688-7572
NPI assigned
May 13, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

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

Authorized official

Name
Tyler Prisbrey
Title
Cfo
Phone
(435) 586-1112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1449 N 1400 W Ste 19
St George, UT 84770-5237

Mailing address

440 N Paiute Dr
Cedar City, UT 84720-2681
Phone (435) 586-1112

Other names 1

  • Shivwits Medical Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, UT3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040127000849 TX Part B Supplier - Clinic/Group Practice 3072414952 Receives reassigned benefits from 18 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cedar City, UT; Ivins, UT; Kanosh, UT; Richfield, UT; St George, UT
O20240716002350 UT Part A Provider - Indian Health Services Facility 3072414952 Practice locations: Saint George, UT
O20241126002275 UT Part A Provider - Indian Health Services Facility 3072414952 Practice locations: Ivins, UT

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

110 W 1325 N
Ste 200
Cedar City, UT 84721
Phone (435) 586-7676

600 N 100 E
Cedar City, UT 84721

795 N Paiute Way
Richfield, UT 84701
Phone (435) 893-0977

Practitioners & affiliated clinicians

Practitioners 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707782400000",
    "number": "1801063441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 N PAIUTE DR",
            "city": "CEDAR CITY",
            "state": "UT",
            "postal_code": "847202681",
            "telephone_number": "435-586-1112",
            "fax_number": "434-867-1514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1449 N 1400 W STE 19",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847705237",
            "telephone_number": "354-688-8199",
            "fax_number": "435-688-7572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIUTE INDIAN TRIBE OF UTAH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-13",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A",
        "authorized_official_last_name": "PRISBREY",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "435-586-1112"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shivwits Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in St George, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; 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.