Sage Dermatology and Mohs Surgery, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SAGE DERMATOLOGY AND MOHS SURGERY, LLC

Practice address

11760 S 700 E Ste 112
Draper, UT 84020-6605

Phone

(216) 280-1875

NPI assigned

Nov 24, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Angela Brimhall, DONPI 1770773061

Title

Owner

Phone

(216) 280-1875

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

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

• Angela Keaka Brimhall, D.O., M.S.

  • Dermatology Physician
  • Draper, UT
  • NPI 1770773061
  Medicare reassignment Care Compare group NPD Authorized official
• Nicole L Rawle, APRN

  • Nurse Practitioner
  • Provo, UT
  • NPI 1669777314
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1700784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702598400000",
    "number": "1841065463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2932 N 1130 W",
            "city": "PLEASANT GROVE",
            "state": "UT",
            "postal_code": "840628055",
            "telephone_number": "216-280-1875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11760 S 700 E STE 112",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840206605",
            "telephone_number": "216-280-1875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE DERMATOLOGY AND MOHS SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-24",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A",
        "authorized_official_last_name": "BRIMHALL",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "216-280-1875",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3011678",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maddie Ruesch
• Lauren Ruonavaara
• RVH Incorporated
• RX Renewal of California, PC
• Sylvia Saahene, PHARMD
• Sage Family Counseling, PLLC
• Leslie Saguilan- Lopez
• Essence Salazar
• Noelia Salcedo
• Arlene Maire Samen, APRN

• Dermatology Physician in Draper, UT
• Providers in Draper, UT by specialty
• Dermatology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.