NPIMap

Organization Active NPI

Health Clinics of Utah

  • State or Local Public Health Clinic/Center
  • Provo, UT
National Provider Identifier
1982669982
Registry record updated May 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X
License
1610961205 Issued in UT
Legal business name
HEALTH CLINICS OF UTAH
Practice address
150 E. Center St.
#1100
Provo, UT 84606
Phone
(801) 374-7011
Fax
(801) 374-7009
NPI assigned
Apr 20, 2006
Last updated
May 18, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2012

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

Authorized official

Name
Miss Stacey Marie Keyes, CPC
Title
Health Program Representative-Bille
Phone
(801) 626-3353

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
State or Local Public Health Clinic/Center 261QP0905X 1610961205 UT Primary
State or Local Public Health Clinic/Center 261QP0905X 105991-1206 UT
State or Local Public Health Clinic/Center 261QP0905X 285456-4405 UT

Addresses

Primary practice location

150 E. Center St.
#1100
Provo, UT 84606

Mailing address

150 E Center St.
#1100
Provo, UT 84606
Phone (801) 374-7011

Other identifiers 3

IdentifierTypeStateIssuer
05665MedicaidUT
535501136001MedicaidUT
05664MedicaidUT

Other names 1

  • State of Utah Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040117000195 UT Part B Supplier - Clinic/Group Practice 6800797333 Receives reassigned benefits from 86 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: American Fork, UT; Ogden, UT; Provo, UT; Salt Lake City, UT

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

150 E Center St
Ste 1100
Provo, UT 84606
Phone (801) 374-7011

Practitioners & affiliated clinicians

Practitioners 10

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": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337299200000",
    "number": "1982669982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 E CENTER ST.",
            "address_2": "#1100",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "84606",
            "telephone_number": "801-374-7011",
            "fax_number": "801-374-7009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 E. CENTER ST.",
            "address_2": "#1100",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "84606",
            "telephone_number": "801-374-7011",
            "fax_number": "801-374-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH CLINICS OF UTAH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2012-05-18",
        "status": "A",
        "authorized_official_last_name": "KEYES",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "HEALTH PROGRAM REPRESENTATIVE-BILLE",
        "authorized_official_telephone_number": "801-626-3353",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": "UT",
            "license": "1610961205",
            "primary": true
        },
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": "UT",
            "license": "105991-1206",
            "primary": false
        },
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": "UT",
            "license": "285456-4405",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05665",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "535501136001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05664",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "State of Utah",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2012; 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.