Individual provider Active NPI

Kelly D Nolan, MD

  • Surgery Physician
  • Murray, UT
National Provider Identifier
1881709889
Registry record updated Oct 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
49777881205 Issued in UT
Practice address
5770 S 250 E
Suite 385
Murray, UT 84107-8100
Phone
(801) 314-4475
Fax
(801) 314-4555
NPI assigned
Aug 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 49777881205 UT Primary

Addresses

Primary practice location

5770 S 250 E
Suite 385
Murray, UT 84107-8100

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 314-4475

Other identifiers 1

IdentifierTypeStateIssuer
942854057059MedicaidUT

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061122000481 UT Practitioner - General Surgery 1355372012 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Temple University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, shared by 68 NPIs, 3,948 clinicians

Practice addresses (Care Compare)

700 S Hwy 99
Suite 3
Fillmore, UT 84631-5137
Phone (435) 743-5555

Hospital & facility affiliations

  • Intermountain Health Alta View Hospital Hospital, Sandy, UT, CCN 460044
  • Intermountain Medical Center Hospital, Murray, UT, CCN 460010

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
49777881205UTMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services Inc CurrentSince Sep 1, 2006 Accepting new patients
Ihc Health Services Inc CurrentSince Sep 1, 2006 Accepting new patients
Ihc Health Services, Inc. CurrentSince Sep 1, 2006 Accepting new patients
Ihc Health Services Inc Surgery Current Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

5770 S 250 E
Ste 385
Murray, UT 84107
Phone (801) 314-4475

5169 S Cottonwood St
Ste 410
Salt Lake City, UT 84107
Phone (801) 507-1600

5169 S Cottonwood St
Ste 400
Salt Lake City, UT 84107
Phone (801) 507-3460

400 C St
Salt Lake Cty, UT 84143
Phone (435) 688-4080

9450 S 1300 E
Ste 210
Sandy, UT 84094
Phone (801) 501-4305

9450 S 1300 E
Sandy, UT 84094
Phone (801) 501-2133

Organizations & group practices 6

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193011200000",
    "number": "1881709889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-314-4475",
            "fax_number": "801-314-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5770 S 250 E",
            "address_2": "SUITE 385",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841078100",
            "telephone_number": "801-314-4475",
            "fax_number": "801-314-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOLAN",
        "first_name": "KELLY",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-20",
        "last_updated": "2007-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "UT",
            "license": "49777881205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "942854057059",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

Verify at the official NPI Registry.