NPIMap

Individual provider Active NPI

Susan Lloyd Jellum, APRN

  • Family Nurse Practitioner
  • Murray, UT
National Provider Identifier
1891422689
Registry record updated Feb 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
206231-4405 Issued in UT
Practice address
5171 S Cottonwood St # 305
Murray, UT 84107-5704
Phone
(801) 507-9310
NPI assigned
Aug 2, 2022
Last updated
Feb 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 206231-4405 UT Primary
Student in an Organized Health Care Education/Training Program 390200000X 206231-3102 UT

Addresses

Primary practice location

5171 S Cottonwood St # 305
Murray, UT 84107-5704

Mailing address

538 N 750 E
Bountiful, UT 84010-2816
Phone (480) 684-0550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221109001238 UT Practitioner - Nurse Practitioner 0345482683 Reassigns benefits to 1 organization
I20251215000697 CO Practitioner - Nurse Practitioner 0345482683 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Platte Valley Medical Group LLCGroup PAC ID 5890054100, 120 clinicians
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

1600 Prairie Ctr Pkwy
Brighton, CO 80601-4006
Phone (303) 498-1600

4859 Yampa St
Denver, CO 80249-7760
Phone (303) 498-1885

5171 S Cottonwood St
Salt Lake City, UT 84107-5704
Phone (801) 507-7751

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
206231-4405UTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Oct 31, 2022 Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Dec 7, 2025 Accepting new patients
Ihc Health Services Inc CurrentSince Oct 31, 2022 Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Dec 7, 2025 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Intermountain Medical Group Denver, LLC Past Accepting new patients
Hospice at Home of Arizona LLC PastSince Mar 5, 2013 Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

12905 W 40th Ave
Ste 505
Golden, CO 80401
Phone (303) 265-5470

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

395 W Cougar Blvd
Ste 101
Provo, UT 84604
Phone (801) 357-8156

3741 W 12600 S
Ste 220
Riverton, UT 84065
Phone (801) 285-2033

8 Th Ave C St
Salt Lake City, UT 84143
Phone (801) 408-5482

5171 S Cottonwood St
South Salt Lake, UT 84107
Phone (801) 507-4000

Organizations & group practices 9

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.

Hospital & facility affiliations 10

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": "1659398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738886400000",
    "number": "1891422689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 N 750 E",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840102816",
            "telephone_number": "480-684-0550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5171 S COTTONWOOD ST # 305",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075704",
            "telephone_number": "801-507-9310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JELLUM",
        "first_name": "SUSAN",
        "middle_name": "LLOYD",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-02",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "206231-4405",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "UT",
            "license": "206231-3102",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

Verify at the official NPI Registry.