NPIMap

Organization Active NPI

Ellsworth Foot and Ankle Clinic

  • Foot & Ankle Surgery Podiatrist
  • Riverton, UT
National Provider Identifier
1942549795
Registry record updated Sep 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
8400193-0501 Issued in UT
Legal business name
ELLSWORTH FOOT AND ANKLE CLINIC
Practice address
12523 S Creek Meadow Rd Ste 105
Riverton, UT 84065
Phone
(801) 253-6886
Fax
(801) 253-6888
NPI assigned
Feb 13, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2021

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

Authorized official

Name
Ryan Ellsworth, DPMNPI 1104130574
Title
Owner, Manager
Phone
(801) 550-0955

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
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 8400193-0501 UT Primary

Addresses

Primary practice location

12523 S Creek Meadow Rd Ste 105
Riverton, UT 84065

Mailing address

12523 S Creek Meadow Rd Ste 105
Riverton, UT 84065-7299
Phone (801) 253-6886

Other practice location 1

4019 W 12600 S
Suite 120
Riverton, UT 84096-7401
Phone (801) 253-6886

Other practice location 2

4019 W 12600 S
Suite 120
Riverton, UT 84096-7401
Phone (801) 253-6886

Other practice location 3

3130 S Highland Dr # B4
Salt Lake City, UT 84106-3095
Phone (801) 253-6886

Other practice location 4

777 N 500 W Ste 103
Provo, UT 84601-1552
Phone (801) 253-6886

Other practice location 5

357 N Main Street
Huntington, UT 84528
Phone (801) 253-6886

Other practice location 6

2019 E Riverside Dr Ste A101
St George, UT 84790-8147
Phone (801) 253-6886

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211110001673 UT Part B Supplier - Clinic/Group Practice 2062778160 Receives reassigned benefits from 6 practitioners
Practice locations: St George, UT; Salt Lake City, UT; Riverton, UT

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

12780 Race Track Rd
Ste 417
Tampa, FL 33626
Phone (813) 221-7336

3130 S Highland Dr
Ste B
Millcreek, UT 84106

3130 S Highland Dr
Ste A2
Millcreek, UT 84106

3130 S Highland Dr
Millcreek, UT 84106

Practitioners & affiliated clinicians

Practitioners 10

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": "1360713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632873600000",
    "number": "1942549795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12523 S CREEK MEADOW RD STE 105",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840657299",
            "telephone_number": "801-253-6886",
            "fax_number": "801-253-6888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12523 S CREEK MEADOW RD STE 105",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "84065",
            "telephone_number": "801-253-6886",
            "fax_number": "801-253-6888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4019 W 12600 S",
            "address_2": "Suite 120",
            "address_purpose": "LOCATION",
            "city": "Riverton",
            "state": "UT",
            "postal_code": "840967401",
            "country_code": "US",
            "telephone_number": "801-253-6886",
            "fax_number": "801-253-6888",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4019 W 12600 S",
            "address_2": "Suite 120",
            "address_purpose": "LOCATION",
            "city": "Riverton",
            "state": "UT",
            "postal_code": "840967401",
            "country_code": "US",
            "telephone_number": "801-253-6886",
            "fax_number": "801-253-6888",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3130 S Highland Dr # B4",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841063095",
            "country_code": "US",
            "telephone_number": "801-253-6886",
            "fax_number": "801-253-6888",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "777 N 500 W Ste 103",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846011552",
            "country_code": "US",
            "telephone_number": "801-253-6886",
            "fax_number": "801-253-6888",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "357 N Main Street",
            "address_purpose": "LOCATION",
            "city": "Huntington",
            "state": "UT",
            "postal_code": "84528",
            "country_code": "US",
            "telephone_number": "801-253-6886",
            "fax_number": "801-253-6888",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2019 E Riverside Dr Ste A101",
            "address_purpose": "LOCATION",
            "city": "St George",
            "state": "UT",
            "postal_code": "847908147",
            "country_code": "US",
            "telephone_number": "801-253-6886",
            "fax_number": "801-253-6888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ELLSWORTH FOOT AND ANKLE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-13",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A",
        "authorized_official_last_name": "ELLSWORTH",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER, MANAGER",
        "authorized_official_telephone_number": "801-550-0955",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "UT",
            "license": "8400193-0501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverton, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; 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.