Individual provider Active NPI

Michael Hacking

  • Psychiatric/Mental Health Nurse Practitioner
  • Salt Lake City, UT
National Provider Identifier
1841764529
Registry record updated Mar 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
5804920-4405 Issued in UT
Practice address
4460 S Highland Dr
Salt Lake City, UT 84124-3543
Phone
(888) 949-4864
NPI assigned
Jan 16, 2019
Last updated
Mar 20, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X 5804920-3102 UT
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 5804920-4405 UT Primary

Addresses

Primary practice location

4460 S Highland Dr
Salt Lake City, UT 84124-3543

Mailing address

4460 S Highland Dr
Salt Lake City, UT 84124-3543
Phone (888) 949-4864

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200413001799 UT Practitioner - Nurse Practitioner 1759711849 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5804920-3102UTMDPsychiatric/Mental Health Registered Nurse
5804920-4405UTMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Behavioral Health Incorporated Psychiatric/Mental Health CurrentSince Mar 12, 2020 Accepting new patients
Valley Mental Health Incorporated Psychiatric/Mental Health Current Accepting new patients

Locations

4460 S Highland Dr
Ste 230
Slc, UT 84124
Phone (801) 263-7227

4460 S Highland Dr
Slc, UT 84124
Phone (801) 263-7101

1020 S Main St
Slc, UT 84101
Phone (801) 536-6500

3809 W 6200 S
Taylorsville, UT 84129
Phone (801) 963-4200

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": "1547596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584662400000",
    "number": "1841764529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4460 S HIGHLAND DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841243543",
            "telephone_number": "888-949-4864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4460 S HIGHLAND DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841243543",
            "telephone_number": "888-949-4864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKING",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-16",
        "last_updated": "2020-03-20",
        "certification_date": "2020-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "UT",
            "license": "5804920-3102",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "UT",
            "license": "5804920-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.