NPIMap

Organization Active NPI

Biorestoration Medical

  • Family Medicine Physician
  • Draper, UT
National Provider Identifier
1902286297
Registry record updated Jun 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
6543672-8906 Issued in UT
Legal business name
BIORESTORATION MEDICAL
Practice address
12340 S 450 E
Draper, UT 84020-8154
Phone
(801) 501-9797
NPI assigned
Jun 2, 2015
Last updated
Jun 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2015

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

Authorized official

Name
Jeffrey S Nelson, D.O.
Title
Medical Director
Phone
(801) 501-9797

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 6543672-8906 UT Primary

Addresses

Primary practice location

12340 S 450 E
Draper, UT 84020-8154

Mailing address

12340 S 450 E
Draper, UT 84020-8154
Phone (801) 501-9797

Other identifiers 1

IdentifierTypeStateIssuer
1619961315OtherUTNPI

National Provider Directory

National Provider Directory

Locations

12101 S State St
Ste 100
Draper, UT 84020

12101 S State St
Ste 101
Draper, UT 84020

Practitioners & affiliated clinicians

Practitioners 11

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": "1433203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433203200000",
    "number": "1902286297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12340 S 450 E",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840208154",
            "telephone_number": "801-501-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12340 S 450 E",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840208154",
            "telephone_number": "801-501-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIORESTORATION MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-02",
        "last_updated": "2015-06-02",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "801-501-9797",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "6543672-8906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1619961315",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Draper, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.