NPIMap

Individual provider Active NPI

Mark S Shockey, MD

  • Pulmonary Disease Physician
  • Salt Lake City, UT
National Provider Identifier
1902839657
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
163879-1205 Issued in UT
Practice address
1220 E 3900 S Ste 2C
Salt Lake City, UT 84124-1319
Phone
(801) 263-2482
Fax
(801) 263-2424
NPI assigned
Jul 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 163879-1205 UT
Pulmonary Disease Physician 207RP1001X 163879-1205 UT Primary

Addresses

Primary practice location

1220 E 3900 S Ste 2C
Salt Lake City, UT 84124-1319

Mailing address

1220 E 3900 S Ste 2C
Salt Lake City, UT 84124-1319
Phone (801) 263-2482

Other identifiers 7

IdentifierTypeStateIssuer
QM0000018088OtherALTIUS
107004966101OtherSELECT CARE
870450466SH1OtherEMIA
PR07070OtherMOLINA
1408OtherUNIV OF UTAH
36670OtherDMBA
68893OtherPEHP

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
163879-1205UTMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Utah Healthcare Corporation Past Accepting new patients

Organizations & group practices 1

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": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192579200000",
    "number": "1902839657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 E 3900 S STE 2C",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241319",
            "telephone_number": "801-263-2482",
            "fax_number": "801-263-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 E 3900 S STE 2C",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241319",
            "telephone_number": "801-263-2482",
            "fax_number": "801-263-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOCKEY",
        "first_name": "MARK",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2007-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "UT",
            "license": "163879-1205",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "UT",
            "license": "163879-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS",
            "identifier": "QM0000018088",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECT CARE",
            "identifier": "107004966101",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMIA",
            "identifier": "870450466SH1",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA",
            "identifier": "PR07070",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIV OF UTAH",
            "identifier": "1408",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "36670",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "68893",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; 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.