NPIMap

Organization Active NPI

Central Utah Foot Clinic, LLC

  • Foot & Ankle Surgery Podiatrist
  • Provo, UT
National Provider Identifier
1881729507
Registry record updated Jan 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
102652-0501 Issued in UT
Legal business name
CENTRAL UTAH FOOT CLINIC, LLC
Practice address
150 W 800 N
Provo, UT 84601-1624
Phone
(801) 375-5353
Fax
(801) 375-5395
NPI assigned
Feb 22, 2007
Last updated
Jan 3, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2008

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

Authorized official

Name
Mark F Rogers, D.P.M.NPI 1619958345
Title
Partner
Phone
(801) 375-5353

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 102652-0501 UT Primary

Addresses

Primary practice location

150 W 800 N
Provo, UT 84601-1624

Mailing address

150 W 800 N
Provo, UT 84601-1624
Phone (801) 375-5353

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080317000404 UT Part B Supplier - Clinic/Group Practice 2264517101 Receives reassigned benefits from 5 practitioners
Practice locations: American Fork, UT; Provo, UT
O20100930048390 UT DME Supplier - Physician - Podiatry 2264517101 Practice locations: Provo, UT

National Provider Directory

National Provider Directory
Tax ID family
Central Utah Foot Clini3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

150 W 800 N
Provo, UT 84601
Phone (801) 375-5353

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199318400000",
    "number": "1881729507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 W 800 N",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846011624",
            "telephone_number": "801-375-5353",
            "fax_number": "801-375-5395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 W 800 N",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846011624",
            "telephone_number": "801-375-5353",
            "fax_number": "801-375-5395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL UTAH FOOT CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2008-01-03",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "801-375-5353",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "UT",
            "license": "102652-0501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; 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.