Cameron Dortch, MPAS, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7800191-1206 Issued in UT

Practice address

1959 Aaron Dr # F
Tooele, UT 84074

Phone

(435) 843-1225

NPI assigned

Oct 15, 2010

Sex

Male

Sole proprietor

No

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.

• Valley Family Medicine PC

  • Family Medicine Physician
  • Tooele, UT
  • NPI 1033412481

  UT

  Medicare reassignment

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 15, 2010.

{
    "created_epoch": "1287100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287100800000",
    "number": "1982914693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 WEST NAUTICAL DR",
            "city": "STANSBURY PARK",
            "state": "UT",
            "postal_code": "84074",
            "telephone_number": "801-787-4780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1959 AARON DR # F",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "84074",
            "telephone_number": "435-843-1225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORTCH",
        "first_name": "CAMERON",
        "credential": "MPAS, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-15",
        "last_updated": "2010-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "7800191-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• John Antoni Douglas, D.O.
• Suzette Dow
• Juliet Dowdle, MFT
• Sarah Rebecca Droubay, LMFT
• Eva Duarte, BHCM

• All providers in Tooele, UT
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.