Active NPI
Crystal Health Solutions Michigan LLC
- Preventive Medicine/Occupational Environmental Medicine Physician
- North Salt Lake, UT
National Provider Identifier
1912763517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Preventive Medicine/Occupational Environmental Medicine Physician
- Legal business name
- CRYSTAL HEALTH SOLUTIONS MICHIGAN LLC
- Practice address
- 160 Cutler Dr Ste 200
North Salt Lake, UT 84054-2967 - Phone
- (801) 631-3570
- NPI assigned
- Feb 22, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jacob C Moench
- Title
- Owner
- Phone
- (385) 368-6377
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Preventive Medicine/Occupational Environmental Medicine Physician | 2083P0500X | Primary |
Addresses
Primary practice location
160 Cutler Dr Ste 200
North Salt Lake, UT 84054-2967
Mailing address
721 N Main St # 220
Layton, UT 84041-2231
Phone (801) 631-3570
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240924003824 | UT | Part B Supplier - Clinic/Group Practice | 5496296345 |
Receives reassigned benefits from 2 practitioners Practice locations: Farmington, UT |
National Provider Directory
National Provider Directory- Tax ID family
- Crystal Health Solutions Michigan LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Mail Order Pharmacy
- North Salt Lake, UT
- NPI 1396600342
Locations
240 N East Promontory
Ofc
Farmington, UT 84025
Phone (801) 631-3570
240 N East Promontory
Ofc 228
Farmington, UT 84025
Phone (801) 631-3570
160 Cutler Dr
Ste 200
North Salt Lake, UT 84054
Phone (801) 631-3570
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": "1708560000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1755216000000",
"number": "1912763517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "721 N MAIN ST # 220",
"city": "LAYTON",
"state": "UT",
"postal_code": "840412231",
"telephone_number": "801-631-3570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 CUTLER DR STE 200",
"city": "NORTH SALT LAKE",
"state": "UT",
"postal_code": "840542967",
"telephone_number": "801-631-3570"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CRYSTAL HEALTH SOLUTIONS MICHIGAN LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-02-22",
"last_updated": "2025-08-15",
"certification_date": "2025-08-15",
"status": "A",
"authorized_official_last_name": "MOENCH",
"authorized_official_first_name": "JACOB",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "385-368-6377"
},
"taxonomies": [
{
"code": "2083P0500X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Salt Lake, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2025; 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.