Active NPI
Simon Faavaoga
- Community Health Worker
- Murray, UT
National Provider Identifier
1821637232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 179 W Winchester St
Murray, UT 84107-7237 - Phone
- (801) 904-3826
- NPI assigned
- Jan 2, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
179 W Winchester St
Murray, UT 84107-7237
Mailing address
9045 S 1300 E
Sandy, UT 84094-3134
Phone (801) 666-6834
Other names 1
- Simon Faavaoga
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | KaleidaCare | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Live for Life Aspen, LLC | Current | Accepting new patients | |
| Utah Family Multi Care Services, LLC | Current | Accepting new patients |
Locations
179 W Winchester St
Murray, UT 84107
Phone (801) 666-6834
9045 S 1300 E
Sandy, UT 84094
Phone (801) 666-6834
Organizations & group practices 2
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.
-
- Mental Health Counselor
- Murray, UT
- NPI 1073155529
-
- Mental Illness Community Based Residential Treatment Facility
- West Jordan, UT
- NPI 1295046100
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601856000000",
"number": "1821637232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9045 S 1300 E",
"city": "SANDY",
"state": "UT",
"postal_code": "840943134",
"telephone_number": "801-666-6834",
"fax_number": "801-904-0272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "179 W WINCHESTER ST",
"city": "MURRAY",
"state": "UT",
"postal_code": "841077237",
"telephone_number": "801-904-3826"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAAVAOGA",
"first_name": "SIMON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-01-02",
"last_updated": "2020-10-05",
"certification_date": "2020-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "KaleidaCare",
"affiliation": "N",
"endpointDescription": "KaleidaCare",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "179 W Winchester St",
"city": "Murray",
"state": "UT",
"country_code": "US",
"postal_code": "841077237",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "SIMON",
"last_name": "FAAVAOGA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Murray, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.