NPIMap

Individual provider Active NPI

Brenten Clark Pugh, M.D.

  • Family Medicine Physician
  • West Jordan, UT
National Provider Identifier
1891742508
Registry record updated Aug 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5054030-1205 Issued in UT
Practice address
7478 Campus View Dr
Suite 100
West Jordan, UT 84084-1966
Phone
(801) 280-7774
Fax
(801) 748-2790
NPI assigned
May 28, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5054030-1205 UT Primary

Addresses

Primary practice location

7478 Campus View Dr
Suite 100
West Jordan, UT 84084-1966

Mailing address

PO Box 572528
Salt Lake City, UT 84157-2528
Phone (801) 747-7279

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050308000416 UT Practitioner - Family Practice 9931153483 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Utah School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jordan Landing Family Medicine LLCGroup PAC ID 5193825131, 3 clinicians

Practice addresses (Care Compare)

3895 W 7800
Suite 100
West Jordan, UT 84088-5616
Phone (801) 280-7774

Hospital & facility affiliations

  • Holy Cross Hospital-Jordan Valley Hospital, West Jordan, UT, CCN 460051
  • Intermountain Medical Center Hospital, Murray, UT, CCN 460010
  • Intermountain Health Alta View Hospital Hospital, Sandy, UT, CCN 460044
  • Intermountain Health Riverton Hospital Hospital, Riverton, UT, CCN 460058
  • University of Utah Hospital and Clinics Hospital, Salt Lake City, UT, CCN 460009

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Jordan Landing Family Medicine LLC Family Medicine CurrentSince Jan 1, 2007 Accepting new patients
Brenten C Pugh, MD Family Medicine CurrentSince Jul 16, 2003 Accepting new patients
Ihc Health Services, Inc. Past Accepting new patients

Locations

1990 W 7800 S
West Jordan, UT 84088
Phone (801) 256-0009

7478 S Campus View Dr
Ste 100
West Jordan, UT 84084
Phone (801) 210-2445

3895 W 7800 S
Ste 100
West Jordan, UT 84088
Phone (801) 280-7774

Organizations & group practices 3

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 7

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": "1148774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186963200000",
    "number": "1891742508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 572528",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841572528",
            "telephone_number": "801-747-7279",
            "fax_number": "801-747-7237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7478 CAMPUS VIEW DR",
            "address_2": "SUITE 100",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840841966",
            "telephone_number": "801-280-7774",
            "fax_number": "801-748-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUGH",
        "first_name": "BRENTEN",
        "middle_name": "CLARK",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-28",
        "last_updated": "2007-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "5054030-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Jordan, UT

Sources for this page

Verify at the official NPI Registry.