NPIMap

Organization Active NPI

State of Utah

  • Psychiatric Hospital
  • Provo, UT
National Provider Identifier
1811978620
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
STATE OF UTAH
Practice address
1300 E Center St
Provo, UT 84606-3554
Phone
(801) 344-4400
Fax
(801) 344-4225
NPI assigned
Nov 9, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Authorized official

Name
Dallas Earnshaw, APRNNPI 1780777649
Title
Superintendent
Phone
(801) 344-4200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

1300 E Center St
Provo, UT 84606-3554

Mailing address

PO Box 270
Provo, UT 84603-0270
Phone (801) 344-4400

Other names 1

  • Utah State Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040117000195 UT Part B Supplier - Clinic/Group Practice 6800797333 Receives reassigned benefits from 86 practitioners
4 other NPIs on this enrollment
Practice locations: American Fork, UT; Ogden, UT; Provo, UT; Salt Lake City, UT
O20050721000487 UT Part A Provider - Hospital 6800797333 Practice locations: Provo, UT

Hospital certification: CCN 464001

Legal name
STATE OF UTAH
Doing business as
UTAH STATE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 1, 1966
Last certification
Mar 9, 2000
Beds
384 (289 certified)
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
1300 East Center Street
Provo, UT 84606-3554
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Utah State HospitalCCN 464001
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
San Juan Counseling Ctr28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Thomas H Riley Individual Corporate OfficerCfo Mar 3, 2020
Dallas L Earnshaw Individual Operational/Managerial ControlSuperintendent Jul 1, 2005 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
William E Christoffersen Salt Lake Veterans HomeSalt Lake City, UT, CCN 465150 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Nov 1, 2008
Nov 1, 2008
George E. Wahlen Ogden Veterans HomeOgden, UT, CCN 465172 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 9, 2009
Jun 9, 2009
Mervyn Sharp Bennion Central Utah Veterans HomePayson, UT, CCN 465181 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Aug 20, 2012
Aug 20, 2012
Southern Utah Veterans Home - IvinsIvins, UT, CCN 465180 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Aug 20, 2012
Aug 20, 2012

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 92

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

View all 92

NPI Registry JSON

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

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1811978620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846030270",
            "telephone_number": "801-344-4400",
            "fax_number": "801-344-4225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 E CENTER ST",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846063554",
            "telephone_number": "801-344-4400",
            "fax_number": "801-344-4225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF UTAH",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-09",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A",
        "authorized_official_last_name": "EARNSHAW",
        "authorized_official_first_name": "DALLAS",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "801-344-4200",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Utah State Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.