Individual provider Active NPI

Elwood N Longenecker, MD

  • Family Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1912004466
Registry record updated Oct 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30831491205 Issued in UT
Practice address
2000 South 900 East
Salt Lake City, UT 84105
Phone
(801) 464-7777
NPI assigned
Sep 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 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 30831491205 UT Primary

Addresses

Primary practice location

2000 South 900 East
Salt Lake City, UT 84105

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 233-4400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040120000003 UT Practitioner - Family Practice 2961303243 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Georgia School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

12473 S Minuteman Dr
Draper, UT 84020-7870
Phone (801) 495-7970

181 E Medical Tower Dr
Murray, UT 84107-4872
Phone (801) 314-7750

2655 W 9000
West Jordan, UT 84088-8542
Phone (801) 568-9933

3723 W 1200
Riverton, UT 84065-7296
Phone (801) 535-7035

3723 W 12600
Riverton, UT 84065-7296

3845 W 4700
Taylorsville, UT 84129-3454
Phone (801) 840-8444

700 S Hwy 99
Suite 3
Fillmore, UT 84631-5137
Phone (801) 357-4600

9450 S 1300
Sandy, UT 84094-5555
Phone (801) 501-6250

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30831491205UTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services Inc CurrentSince Oct 15, 2018 Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

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

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 2

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": "1158624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192838400000",
    "number": "1912004466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-233-4400",
            "fax_number": "801-233-4410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 SOUTH 900 EAST",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84105",
            "telephone_number": "801-464-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONGENECKER",
        "first_name": "ELWOOD",
        "middle_name": "N",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-19",
        "last_updated": "2007-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "30831491205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.