NPIMap

Organization Active NPI

St Mark's Professional Services, LLC

  • Internal Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1912925629
Registry record updated Feb 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ST MARK'S PROFESSIONAL SERVICES, LLC
Practice address
1200 E 3900 S
Salt Lake City, UT 84124-1300
Phone
(801) 268-7860
Fax
(801) 270-3331
NPI assigned
Jul 18, 2006
Last updated
Feb 12, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2010

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

Authorized official

Name
Steve Bateman
Title
Ceo
Phone
(801) 268-7700

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Education NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133NN1002X
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X

Addresses

Primary practice location

1200 E 3900 S
Salt Lake City, UT 84124-1300

Mailing address

PO Box 271220
Salt Lake City, UT 84127-1220
Phone (801) 268-7860

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031218000918 UT Part B Supplier - Clinic/Group Practice 1355248089 Receives reassigned benefits from 15 practitioners
Practice locations: Salt Lake City, UT
O20100316001013 ID Part B Supplier - Clinic/Group Practice 1355248089 Receives reassigned benefits from 21 practitioners
Practice locations: Idaho Falls, ID

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1200 E 3900 S
Ofc
Salt Lake City, UT 84124

Practitioners & affiliated clinicians

Practitioners 44

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265932800000",
    "number": "1912925629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 271220",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841271220",
            "telephone_number": "801-268-7860",
            "fax_number": "801-270-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E 3900 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241300",
            "telephone_number": "801-268-7860",
            "fax_number": "801-270-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARK'S PROFESSIONAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2010-02-12",
        "status": "A",
        "authorized_official_last_name": "BATEMAN",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "801-268-7700"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2010; 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.