NPIMap

Organization Active NPI

Premier Family Medical - Dermatology

  • Dermatology Physician
  • American Fork, UT
National Provider Identifier
1972952828
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
PREMIER FAMILY MEDICAL - DERMATOLOGY
Practice address
1112 E 300 N Ste 301
American Fork, UT 84003-4522
Phone
(801) 642-2950
Fax
(801) 642-2951
NPI assigned
Jun 10, 2016
Last updated
Mar 22, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
PREMIER FAMILY MEDICAL LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

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

Authorized official

Name
Heather Guymon
Title
Credentialing Specialist
Phone
(801) 769-2571

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

1112 E 300 N Ste 301
American Fork, UT 84003-4522

Mailing address

275 W 200 N
Lindon, UT 84042-5009
Phone (801) 796-1333

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130710000079 UT Part B Supplier - Clinic/Group Practice 7416197785 Receives reassigned benefits from 106 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lindon, UT; Vineyard, UT; Saratoga Springs, UT; Pleasant Grove, UT; Lehi, UT; Eagle Mountain, UT; American Fork, UT

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2097405Premier Dermatology1112 East 300 North, Suite 301, American Fork, UT 84003ComplianceOct 23, 2026

National Provider Directory

National Provider Directory
Part of
Premier Family Medical - Eagle Mountain

Locations

48 N 1100 E
American Fork, UT 84003
Phone (801) 642-2950

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1465516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711065600000",
    "number": "1972952828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 W 200 N",
            "city": "LINDON",
            "state": "UT",
            "postal_code": "840425009",
            "telephone_number": "801-796-1333",
            "fax_number": "801-796-0625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 E 300 N STE 301",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840034522",
            "telephone_number": "801-642-2950",
            "fax_number": "801-642-2951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER FAMILY MEDICAL - DERMATOLOGY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIER FAMILY MEDICAL LLC",
        "enumeration_date": "2016-06-10",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A",
        "authorized_official_last_name": "GUYMON",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "801-769-2571"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in American Fork, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.