NPIMap

Individual provider Active NPI

Spencer Gordon Nielson, MD

  • Family Medicine Physician
  • Delta, UT
National Provider Identifier
1962992768
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11390232-1205 Issued in UT
Practice address
140 White Sage Ave
Delta, UT 84624-8928
Phone
(435) 864-3333
NPI assigned
May 16, 2018
Sex
Male
Sole proprietor
No

Organizations & group practices 11

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 10

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

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Utah School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Revere Health PC 407 clinicians

Practice addresses (Care Compare)

140 White Sage Ave
Delta, UT 84624-8928
Phone (435) 864-3333

Hospital & facility affiliations

  • Intermountain Health Home Health - Mt. Pleasant Home health agency, Mt. Pleasant, UT, CCN 467016
  • Intermountain Health Delta Community Hospital Hospital, Delta, UT, CCN 461300
  • Intermountain Health Fillmore Community Hospital Hospital, Fillmore, UT, CCN 461301
  • Intermountain Health Utah Valley Hospital Hospital, Provo, UT, CCN 460001
  • Central Valley Medical Center - Cah Hospital, Nephi, UT, CCN 461304
  • Intermountain Health Sevier Valley Hospital Hospital, Richfield, UT, CCN 460026
  • Millard County Care and Rehabilitation Nursing home, Delta, UT, CCN 465157
  • Intermountain Health Delta Community Hospital Nursing home, CCN 46Z300

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux24
Melanoma (skin cancer) excision23
Removal of tissue1-10
Removal of skin lesions158
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy38

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
I20190903000644 UT Practitioner - Family Practice 5193054039 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc Internal Medicine CurrentSince Jul 25, 2019 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Revere Health PC CurrentSince Jul 26, 2021 Accepting new patients
Revere Health PC CurrentSince Jul 26, 2021 Accepting new patients
Ihc Health Services Inc CurrentSince Jan 29, 2021 Accepting new patients
Ihc Health Services Inc Family Medicine Current Accepting new patients
Ihc Health Services, Inc. CurrentSince Jul 25, 2019 Accepting new patients

Locations

140 White Sage Ave
Delta, UT 84624
Phone (435) 864-3333

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

4403 Harrison Blvd
Ste 700A
Ogden, UT 84403
Phone (801) 387-5322

2400 N Washington Blvd
Ogden, UT 84414
Phone (801) 387-8300

1055 N 500 W
Ste 212
Provo, UT 84604
Phone (801) 374-2362

1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000

1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

905 N 1000 W
Tremonton, UT 84337
Phone (435) 207-4500

Interoperability endpoints

  • Direct secure messaging: spencernielson@cuccu.allscriptsdirect.net

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 11390232-1205 UT Primary

Addresses

NPPES NPI Registry

Primary practice location

140 White Sage Ave
Delta, UT 84624-8928

Mailing address

1055 N 500 W
Attn Credentialing
Provo, UT 84604
Phone (801) 354-8225

Other practice location 1

4403 Harrison Blvd Ste 700A
Ogden, UT 84403-3295
Phone (801) 387-5300

Electronic endpoints 1

NPPES NPI Registry
TypeEndpointUseAffiliation
Direct Messaging Address medreview@reverehealth.com Central Utah Clinic, P.C.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 2, 2021.

{
    "created_epoch": "1526428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625184000000",
    "number": "1962992768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "ATTN CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "84604",
            "telephone_number": "801-354-8225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 WHITE SAGE AVE",
            "city": "DELTA",
            "state": "UT",
            "postal_code": "846248928",
            "telephone_number": "435-864-3333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4403 Harrison Blvd Ste 700A",
            "address_purpose": "LOCATION",
            "city": "Ogden",
            "state": "UT",
            "postal_code": "844033295",
            "country_code": "US",
            "telephone_number": "801-387-5300",
            "fax_number": "801-387-5333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIELSON",
        "first_name": "SPENCER",
        "middle_name": "GORDON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-16",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "11390232-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Central Utah Clinic, P.C.",
            "address_1": "140 White Sage Ave",
            "city": "Delta",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846248928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Delta, UT

Sources for this page

Verify at the official NPI Registry.