NPIMap

Organization Active NPI

Northern Utah Medical Supply LLC

  • Physical Medicine & Rehabilitation Physician
  • Brigham City, UT
National Provider Identifier
1912649609
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
NORTHERN UTAH MEDICAL SUPPLY LLC
Practice address
1030 S Medical Dr Ste a
Brigham City, UT 84302-3281
Phone
(435) 723-9700
Fax
(435) 723-9710
NPI assigned
Apr 12, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2023

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

Authorized official

Name
Jacob Bruce Pugsley, DONPI 1902065824
Title
DO/Owner
Phone
(435) 787-2000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

1030 S Medical Dr Ste a
Brigham City, UT 84302-3281

Mailing address

280 S Main St
Bountiful, UT 84010-6236
Phone (801) 505-0821

Other practice location 1

2310 N 400 E Ste A
Logan, UT 84341-1796
Phone (435) 787-2000

Other names 1

  • HP Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220810000530 UT Part B Supplier - Clinic/Group Practice 7517349434 Receives reassigned benefits from 2 practitioners
Practice locations: Brigham City, UT; Logan, UT
O20221226000122 ID Part B Supplier - Clinic/Group Practice 7517349434 Receives reassigned benefits from 2 practitioners
Practice locations: Preston, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1649721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684886400000",
    "number": "1912649609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 S MAIN ST",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106236",
            "telephone_number": "801-505-0821",
            "fax_number": "801-505-0803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 S MEDICAL DR STE A",
            "city": "BRIGHAM CITY",
            "state": "UT",
            "postal_code": "843023281",
            "telephone_number": "435-723-9700",
            "fax_number": "435-723-9710"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2310 N 400 E Ste A",
            "address_purpose": "LOCATION",
            "city": "Logan",
            "state": "UT",
            "postal_code": "843411796",
            "country_code": "US",
            "telephone_number": "435-787-2000",
            "fax_number": "435-787-1913",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHERN UTAH MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-12",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A",
        "authorized_official_last_name": "PUGSLEY",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "DO/OWNER",
        "authorized_official_telephone_number": "435-787-2000",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HP Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HP Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brigham City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.