Ryan Dennis Church, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

278935-4405 Issued in UT

Practice address

1220 E 3900 S Ste 1F
Salt Lake City, UT 84124-1327

Phone

(801) 262-5711

Fax

(801) 262-5741

NPI assigned

Aug 11, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Physician Group of Utah Inc

  • Specialist
  • South Jordan, UT
  • NPI 1477676930
  Medicare reassignment NPD
• Envision Home Health LLC

  • Community Based Hospice Care Agency
  • Taylorsville, UT
  • NPI 1306946462
  NPD (past)
• Stephen M Hansen MD PC

  • Specialist
  • St George, UT
  • NPI 1205072923
  NPD (past)
• Adegbenga a Adetola M D Inc

  • Nephrology Physician
  • Lynwood, CA
  • NPI 1205152139
  NPD (past)

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605052800000",
    "number": "1912909714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741648",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303741648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 E 3900 S STE 1F",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241327",
            "telephone_number": "801-262-5711",
            "fax_number": "801-262-5741"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "74 E Kimballs Ln Ste 330",
            "address_purpose": "LOCATION",
            "city": "Draper",
            "state": "UT",
            "postal_code": "840205006",
            "country_code": "US",
            "telephone_number": "801-266-3418",
            "fax_number": "801-266-4174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "RYAN",
        "middle_name": "DENNIS",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2020-11-11",
        "certification_date": "2020-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "278935-4405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "27893544001001",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "P99858",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lee Shan Chung, M.D.
• PO Lin Chung, RN
• Church of Jesus Christ of Latter-Day Saints
• Patricia Jean Romney Church, PA-C
• Robert A Church, DPM
• Sarah Jane Church
• John Churchill
• Susan K Churchill, APRN
• Molly Kathleen Chynoweth Prentice, LCSW
• Robert Chynoweth, PT

• Family Nurse Practitioner in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.