NPIMap

Individual provider Active NPI

Roscoe S Nelson, MD

  • Urology Physician
  • American Fork, UT
National Provider Identifier
1962487462
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
13713178-1205 Issued in UT
Practice address
1159 E 200 N Ste 300
American Fork, UT 84003-2037
Phone
(801) 965-3600
NPI assigned
Dec 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 27180 AZ
Urology Physician 208800000X 13713178-1205 UT Primary

Addresses

Primary practice location

1159 E 200 N Ste 300
American Fork, UT 84003-2037

Mailing address

2965 W 3500 S Dept Code902
West Valley City, UT 84119-3602
Phone (801) 965-3600

Other practice location 1

6320 W Union Hills Dr
Bldg B Suite 2600
Glendale, AZ 85308-1096
Phone (602) 942-5600

Other identifiers 1

IdentifierTypeStateIssuer
467870MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241105002803 UT Practitioner - Urology 0941261291 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of California, San Diego School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Granger Medical Clinic PCGroup PAC ID 3476465691, 192 clinicians

Practice addresses (Care Compare)

2965 W 3500
West Valley City, UT 84119-3602
Phone (801) 965-3600

Hospital & facility affiliations

  • American Fork Hospital Hospital, American Fork, UT, CCN 460023
  • Timpanogos Regional Hospital Hospital, Orem, UT, CCN 460052
  • Holy Cross Hospital-Jordan Valley Hospital, West Jordan, UT, CCN 460051
  • University of Utah Hospital and Clinics Hospital, Salt Lake City, UT, CCN 460009

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
27180AZMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Granger Medical Clinic PC CurrentSince Dec 1, 2024 Accepting new patients
Granger Medical Clinic PC CurrentSince Dec 1, 2024 Accepting new patients
Granger Medical Clinic PC Family Medicine Current Accepting new patients
Granger Medical Specialists, LLC CurrentSince Dec 1, 2024 Accepting new patients
Granger Medical Specialists LLC CurrentSince Dec 1, 2024 Accepting new patients
Banner Thunderbird Medical Center Past Accepting new patients

Locations

1159 E 200 N
Ste 300
American Fork, UT 84003
Phone (801) 357-7530

12391 S 4000 W
Riverton, UT 84096
Phone (801) 302-1700

995 W Levoy Dr
Taylorsville, UT 84123

2965 W 3500 S
West Valley City, UT 84119
Phone (801) 965-3505

2965 W 3500 S
#902
West Valley City, UT 84119

Interoperability endpoints

  • Direct secure messaging: roscoe.nelson@urologyaz.eclinicaldirectplus.com

Organizations & group practices 6

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1962487462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2965 W 3500 S DEPT CODE902",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841193602",
            "telephone_number": "801-965-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1159 E 200 N STE 300",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840032037",
            "telephone_number": "801-965-3600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6320 W Union Hills Dr",
            "address_2": "Bldg B Suite 2600",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853081096",
            "country_code": "US",
            "telephone_number": "602-942-5600",
            "fax_number": "623-825-6386",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "ROSCOE",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "AZ",
            "license": "27180",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "UT",
            "license": "13713178-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "467870",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in American Fork, UT

Sources for this page

Verify at the official NPI Registry.