NPIMap

Individual provider Active NPI

Kim A. Halladay, D.P.M.

  • Podiatrist
  • Tooele, UT
National Provider Identifier
1902809528
Registry record updated Dec 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
103966-0501 Issued in UT
Practice address
2356 N 400 E
Ste 104
Tooele, UT 84074-3409
Phone
(435) 882-0711
Fax
(435) 882-1778
NPI assigned
May 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 103966-0501 UT Primary

Addresses

Primary practice location

2356 N 400 E
Ste 104
Tooele, UT 84074-3409

Mailing address

2356 N 400 E
Ste 104
Tooele, UT 84074-3409
Phone (435) 882-0711

Other identifiers 8

IdentifierTypeStateIssuer
0994190001OtherUTDME
480008495OtherUTRAILROAD MEDICARE
QM0000054283OtherUTALTIUS
107006704101OtherUTIHC
2649OtherUTPEHP
870406457 84074OtherUTTRICARE
36338OtherUTDMBA
870406457 HA1OtherUTEMIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Utah Podiatric Physicians and Surgeons Group LLC Podiatrist Past Accepting new patients
Kris a Hill OD PC Past Accepting new patients
Jed C Winder OD, PC PastSince Jan 1, 2008 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: khallada@yourcarecommunity.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292544000000",
    "number": "1902809528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2356 N 400 E",
            "address_2": "STE 104",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "840743409",
            "telephone_number": "435-882-0711",
            "fax_number": "435-882-1778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2356 N 400 E",
            "address_2": "STE 104",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "840743409",
            "telephone_number": "435-882-0711",
            "fax_number": "435-882-1778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLADAY",
        "first_name": "KIM",
        "middle_name": "A.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2010-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "UT",
            "license": "103966-0501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "0994190001",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "480008495",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS",
            "identifier": "QM0000054283",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHC",
            "identifier": "107006704101",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "2649",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "870406457 84074",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "36338",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMIA",
            "identifier": "870406457 HA1",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tooele, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2010; 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.