NPIMap

Organization Active NPI

Shane D Gagon MD, PC

Doing business as Castle Country Family Medicine

  • Family Medicine Physician
  • Price, UT
National Provider Identifier
1982815064
Registry record updated Dec 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
361555-1205 Issued in UT
Legal business name
SHANE D GAGON MD, PC
Doing business as
Castle Country Family Medicine
Practice address
377 No. Fairgrounds Rd.
Price, UT 84501-4211
Phone
(435) 613-2200
Fax
(435) 613-2201
NPI assigned
May 24, 2007
Last updated
Dec 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2010

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

Authorized official

Name
Pat A Stapley
Title
Billing
Phone
(435) 613-2210

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 361555-1205 UT Primary

Addresses

Primary practice location

377 No. Fairgrounds Rd.
Price, UT 84501-4211

Mailing address

377 No. Fairgounds Rd.
Price, UT 84501-4216
Phone (435) 613-2200

Other identifiers 2

IdentifierTypeStateIssuer
DF8294OtherUTRAILROAD MEDICARE
529513346027MedicaidUT

Other names 1

  • CASTLE COUNTRY FAMILY MEDICINE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071031000379 UT Part B Supplier - Clinic/Group Practice 9335236868 Receives reassigned benefits from 12 practitioners
Practice locations: Price, UT; Huntington, UT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291161600000",
    "number": "1982815064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "377 NO. FAIRGOUNDS RD.",
            "city": "PRICE",
            "state": "UT",
            "postal_code": "845014216",
            "telephone_number": "435-613-2200",
            "fax_number": "435-613-2201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "377 NO. FAIRGROUNDS RD.",
            "city": "PRICE",
            "state": "UT",
            "postal_code": "845014211",
            "telephone_number": "435-613-2200",
            "fax_number": "435-613-2201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANE D GAGON MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2010-12-01",
        "status": "A",
        "authorized_official_last_name": "STAPLEY",
        "authorized_official_first_name": "PAT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "435-613-2210"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "361555-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF8294",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529513346027",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CASTLE COUNTRY FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Price, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; 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.