NPIMap

Organization Active NPI

Legacy Anesthesia LLC

  • Anesthesiology Physician
  • Heber City, UT
National Provider Identifier
1851764112
Registry record updated Nov 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
120505 Issued in UT
Legal business name
LEGACY ANESTHESIA LLC
Practice address
1485 S Highway 40
Heber City, UT 84032-3522
Phone
(435) 654-2500
NPI assigned
Nov 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2016

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

Authorized official

Name
Mr. Michael Dagley, CRNANPI 1699790113
Title
President
Phone
(435) 671-1254

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X 120505 UT Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

1485 S Highway 40
Heber City, UT 84032-3522

Mailing address

PO Box 3750
Salt Lake City, UT 84110-3750
Phone (800) 748-4868

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160505001075 UT Part B Supplier - Clinic/Group Practice 9234438649 Receives reassigned benefits from 13 practitioners
Practice locations: Heber City, UT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1447027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479254400000",
    "number": "1851764112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3750",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841103750",
            "telephone_number": "800-748-4868",
            "fax_number": "770-701-6676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1485 S HIGHWAY 40",
            "city": "HEBER CITY",
            "state": "UT",
            "postal_code": "840323522",
            "telephone_number": "435-654-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-09",
        "last_updated": "2016-11-16",
        "status": "A",
        "authorized_official_last_name": "DAGLEY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "435-671-1254",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "120505",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Heber City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.