Individual provider Active NPI

Landon Dickson, M.D.

  • Nephrology Physician
  • South Salt Lake, UT
National Provider Identifier
1912168345
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
8653235-1205 Issued in UT
Practice address
3702 S State St Ste 107
South Salt Lake, UT 84115-5096
Phone
(801) 288-2634
Fax
(801) 288-1186
NPI assigned
Jun 18, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 8653235-1205 UT Primary
Nephrology Physician 207RN0300X 01069604A IN

Addresses

Primary practice location

3702 S State St Ste 107
South Salt Lake, UT 84115-5096

Mailing address

3702 S State St Ste 107
South Salt Lake, UT 84115-5096
Phone (801) 288-2634

Other practice location 1

4101 W Pioneer Pkwy Ste 103
West Valley, UT 84120-2050
Phone (801) 288-2634

Other practice location 2

12523 S Creek Meadow Rd Ste 111
Riverton, UT 84065-7291
Phone (801) 288-2634

Other identifiers 1

IdentifierTypeStateIssuer
1912168345MedicaidUT

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ldickson31403@direct.acumenmd.com

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
I20130731000292 UT Practitioner - Internal MedicinePractitioner - Nephrology 4587801956 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
University of Utah School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nephrology Associates of Utah LLCGroup PAC ID 2769468065, 31 clinicians

Practice addresses (Care Compare)

3702 S State St
Suite 107
S Salt Lake, UT 84115-5096
Phone (801) 288-2634

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology Associates of Utah LLC Nephrology CurrentSince Aug 1, 2013 Accepting new patients
Liberty Dialysis-Woods Cross LLC PastSince Aug 28, 2021 Accepting new patients
Kidney & Hypertension Institute of Utah PLLC Nephrology Past Accepting new patients

Locations

1551 Renaissance Towne Dr
Ste 340
Bountiful, UT 84010
Phone (801) 288-2634

3000 N Triumph Blvd
Ste 340
Lehi, UT 84043
Phone (435) 833-9180

1735 W 2700 N
Pleasant View, UT 84404
Phone (801) 779-3500

12523 S Creek Meadow Rd
Ste 111
Riverton, UT 84065
Phone (801) 288-2634

650 E 4500 S
Ste 210
Salt Lake Cty, UT 84107
Phone (801) 288-2634

3702 S State St
Ste 107
South Salt Lake, UT 84115
Phone (801) 288-2634

1244 N Main St
Ste 101
Tooele, UT 84074
Phone (435) 249-0007

5285 S 400 E
#B
Washington Terrace, UT 84405
Phone (801) 476-7300

3823 W 9000 S
West Jordan, UT 84088
Phone (801) 288-2634

2965 W 3500 S
Fl 2
West Valley City, UT 84119
Phone (801) 288-2634

4101 W Pioneer Pkwy
Ste 103
West Valley City, UT 84120
Phone (801) 288-2634

572 W 750 S
Bldg B
Woods Cross, UT 84010
Phone (801) 292-2658

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14360/brand/23/csg/1/fhir/r4
  • FHIR API: https://api.platform.athenahealth.com/14360/brand/20/csg/1/fhir/r4

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": "1213747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714608000000",
    "number": "1912168345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3702 S STATE ST STE 107",
            "city": "SOUTH SALT LAKE",
            "state": "UT",
            "postal_code": "841155096",
            "telephone_number": "801-288-2634",
            "fax_number": "801-288-1186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 S STATE ST STE 107",
            "city": "SOUTH SALT LAKE",
            "state": "UT",
            "postal_code": "841155096",
            "telephone_number": "801-288-2634",
            "fax_number": "801-288-1186"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4101 W Pioneer Pkwy Ste 103",
            "address_purpose": "LOCATION",
            "city": "West Valley",
            "state": "UT",
            "postal_code": "841202050",
            "country_code": "US",
            "telephone_number": "801-288-2634",
            "fax_number": "801-288-1186",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12523 S Creek Meadow Rd Ste 111",
            "address_purpose": "LOCATION",
            "city": "Riverton",
            "state": "UT",
            "postal_code": "840657291",
            "country_code": "US",
            "telephone_number": "801-288-2634",
            "fax_number": "801-288-1186",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKSON",
        "first_name": "LANDON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-18",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "UT",
            "license": "8653235-1205",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "01069604A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912168345",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ldickson31403@direct.acumenmd.com",
            "affiliation": "N",
            "address_1": "3702 S State St Ste 107",
            "city": "South Salt Lake",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841155096",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Salt Lake, UT

Sources for this page

Verify at the official NPI Registry.