NPIMap

Organization Active NPI

Ihc Health Services Inc

Doing business as Intermountain North Canyon Family Practice

  • Family Medicine Physician
  • Provo, UT
National Provider Identifier
1992831218
Registry record updated Feb 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
33829 Issued in UT
Legal business name
IHC HEALTH SERVICES INC
Doing business as
Intermountain North Canyon Family Practice
Utah Valley Family Medicine
Practice address
395 W Cougar Blvd Ste B
Provo, UT 84604-3311
Phone
(801) 373-3300
NPI assigned
Feb 23, 2007
Last updated
Feb 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2021

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

Authorized official

Name
Dr. Mark Briesacher, MD
Title
SVP-Chief Phy Executive
Phone
(801) 442-3495

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 33829 UT Primary

Addresses

Primary practice location

395 W Cougar Blvd Ste B
Provo, UT 84604-3311

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 373-3300

Other practice location 1

3200 N Canyon Rd
Suite D
Provo, UT 84604-4571
Phone (801) 373-3300

Other names 2

  • Intermountain North Canyon Family Practice Doing business as
  • Utah Valley Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031105000079 UT Part B Supplier - Clinic/Group Practice 1850209420 Receives reassigned benefits from 1,923 practitioners
This NPI is an additional NPI on the enrollment
O20080610000303 UT Part B Supplier - Clinic/Group Practice 1850209420 Receives reassigned benefits from 4,146 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Locations

395 W Cougar Blvd
Ste B
Provo, UT 84604
Phone (801) 373-3300

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612137600000",
    "number": "1992831218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-373-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 W COUGAR BLVD STE B",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043311",
            "telephone_number": "801-373-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 N Canyon Rd",
            "address_2": "Suite D",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846044571",
            "country_code": "US",
            "telephone_number": "801-373-3300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IHC HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A",
        "authorized_official_last_name": "BRIESACHER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "SVP-CHIEF PHY EXECUTIVE",
        "authorized_official_telephone_number": "801-442-3495",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "33829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Intermountain North Canyon Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Utah Valley Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 1, 2021; 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.