Individual provider Active NPI

Gaven Sepulveda

  • Clinical Social Worker
  • Vernal, UT
National Provider Identifier
1841629748
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
1140 W 500 S Ste 9
Vernal, UT 84078-2912
Phone
(435) 789-6300
Fax
(435) 789-6357
NPI assigned
Nov 1, 2013
Last updated
May 18, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Other Technician 247200000X
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

1140 W 500 S Ste 9
Vernal, UT 84078-2912

Mailing address

1140 W 500 S Ste 9
Vernal, UT 84078-2912
Phone (435) 789-6300

Other practice location 1

1273 W 12600 S Ste 403
Riverton, UT 84065-7111
Phone (801) 930-0411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240304002923 UT Practitioner - Clinical Social Worker 2466897129 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1140 W 500
Vernal, UT 84078-2914
Phone (435) 789-6300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Uintah Basin Tri-Co Mental Health & Substance Abuse Local Authority CurrentSince Feb 8, 2024 Accepting new patients
Mountain View Family Therapy LLC Clinical PastSince Jan 1, 2022 Accepting new patients

Locations

1140 W 500 S
Ste 9
Vernal, UT 84078

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1383264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652832000000",
    "number": "1841629748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 W 500 S STE 9",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "840782912",
            "telephone_number": "435-789-6300",
            "fax_number": "435-789-6357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 W 500 S STE 9",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "840782912",
            "telephone_number": "435-789-6300",
            "fax_number": "435-789-6357"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1273 W 12600 S Ste 403",
            "address_purpose": "LOCATION",
            "city": "Riverton",
            "state": "UT",
            "postal_code": "840657111",
            "country_code": "US",
            "telephone_number": "801-930-0411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SEPULVEDA",
        "first_name": "GAVEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-01",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vernal, UT

Sources for this page

Verify at the official NPI Registry.