Sage Functional Medicine Center

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

8689112-4405 Issued in UT

Legal business name

SAGE FUNCTIONAL MEDICINE CENTER

Practice address

55 E 100 N
Suite 303
Logan, UT 84321-4661

Phone

(435) 760-7078

NPI assigned

Mar 9, 2016

Organization subpart

No

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

Authorized official

Name

Lisa Shea Roberts, A.P.R.N, WHNP, FNPNPI 1043652803

Title

Owner/Operator

Phone

(435) 760-7078

Specialties & licenses 1

Addresses

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12929/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Shea Roberts, F.N.P.

  • Family Nurse Practitioner
  • Logan, UT
  • NPI 1043652803
  NPD (past) Authorized official

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

{
    "created_epoch": "1457481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457481600000",
    "number": "1912368549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 E 100 N",
            "address_2": "SUITE 303",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843214661",
            "telephone_number": "435-760-7078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 E 100 N",
            "address_2": "SUITE 303",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843214661",
            "telephone_number": "435-760-7078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE FUNCTIONAL MEDICINE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-09",
        "last_updated": "2016-03-09",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "SHEA",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "435-760-7078",
        "authorized_official_credential": "A.P.R.N, WHNP, FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "UT",
            "license": "8689112-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raquel Batrice Ruggiero, DNP PMHNP
• Linnea Russell, DPT
• Mark Russell, PHARMD, RPH
• Shiree McIff Ryan, LCSW
• Mark Daniel Sabin, DO
• Sagebrush Mental Health, LLC
• Kassi Salas
• David Joshua Salcido, FNP-BC
• Steven S Salisbury, MD
• Salt Hill Counseling, PLLC

• Primary Care Clinic/Center in Logan, UT
• Providers in Logan, UT by specialty
• Primary Care Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2016; 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.