DR. SHAD OUTSEN


Address: 1034 N 500 W, Provo, UT 84604-3380
Phone: 8013577481

DR. SHAD OUTSEN (NPI# 1487815536) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1487815536
Entity Type Individual
Full Name DR. SHAD OUTSEN
Credential M.D.
Practice Address 1034 N 500 W
Provo
UT 84604-3380
Mailing Address Po Box 27128
Salt Lake City
UT 84127-0128
Practice Telephone 8013577481
Enumeration Date 2008-06-21
Last Update Date 2016-09-06
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 2080P0203X Pediatrics
Specialization: Pediatric Critical Care Medicine
7365706-1205 UT Allopathic & Osteopathic Physicians

Office Location

Street Address 1034 N 500 W
City PROVO
State UT
Zip Code 84604-3380

Providers in the same location

NPI Name Taxonomy Address Enumeration
1780671453 Marc Sune Robins Family Medicine 1034 N 500 W, Provo, UT 84604-3380 2005-09-28
1417562885 Mckenzie Hamilton Nurse Practitioner 1034 N 500 W, Provo, UT 84604-3380 2020-09-13
1235741042 Kristi Kay Anderson Nurse Practitioner 1034 N 500 W, Provo, UT 84604-3380 2020-08-21
1255968681 Tiffani Petersen Registered Nurse 1034 N 500 W, Provo, UT 84604-3380 2020-03-25
1477188811 Jodi Benson Dietitian, Registered 1034 N 500 W, Provo, UT 84604-3380 2020-03-05
1649815879 Jessica Ricaurte Nurse Practitioner 1034 N 500 W, Provo, UT 84604-3380 2019-11-12
1174167795 Courtney Danielle Akina Speech-Language Pathologist 1034 N 500 W, Provo, UT 84604-3337 2019-11-06
1396393609 Camille Stanley Speech-Language Pathologist 1034 N 500 W, Provo, UT 84604-3380 2019-08-29
1386292076 Rebecca Harris Occupational Therapist 1034 N 500 W, Provo, UT 84604-3380 2019-08-27
1770139289 Cameron Lee Tingey Nurse Practitioner 1034 N 500 W, Provo, UT 84604-3380 2019-08-12
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1346882107 Abigail Belle Hardy Student in an Organized Health Care Education/Training Program 1190 900 E, Provo, UT 84604 2019-10-14
1386106698 Sarah Roseman Hunt Nurse Practitioner 1055 N 500 W., Suite. 101, Bldg. C, Provo, UT 84604 2019-04-04
1255813325 Hwigeum Jeong Specialist/Technologist Department of Exercise Sciences 106 Sfh Brigham Young, Provo, UT 84604 2018-09-05
1093203044 Snowcap Smile Studio LLC Dentist 2230 N. University Pkwy Ste 8b, Provo, UT 84604 2018-04-25
1407359078 Ihc Health Services Inc Clinic/Center 380 W Bulldog Blvd, Ste 403, Provo, UT 84604 2018-03-09
1902308455 Afton Leuga Nurse Practitioner 395 W Bulldog Blvd., Suite 401, Provo, UT 84604 2018-03-01
1851807333 Ihc Health Services Inc Family Medicine 380 W 1230 N, Ste 602, Provo, UT 84604 2017-12-20
1689180218 Ihc Health Services Inc Pediatrics 395 W Bulldog Blvd Ste 703, Provo, UT 84604 2017-12-19
1396254165 Nicolas Sorensen Massage Therapist 247 West 2230 North #201, Provo, UT 84604 2017-09-25
1437692241 Cirque Lodge Inc Substance Abuse Rehabilitation Facility 3114 E Ida's Road, Sundance, UT 84604 2016-11-28
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Taxonomy Information

Taxonomy Code 2080P0203X
Grouping Allopathic & Osteopathic Physicians
Classification Pediatrics
Specialization Pediatric Critical Care Medicine

Taxonomy Definition

A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics)

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1174039614 Ihc Health Services Inc Pediatrics 1034 N 500 W, Provo, UT 84604-3380 2017-12-20
1982675088 Jon S Woods Pediatrics 1034 N 500 W, Provo, UT 84604-3380 2006-01-28

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1942642541 Elizabeth Quigley Pediatrics 515 E 100 S Ste 200, Salt Lake City, UT 84102-2095 2013-07-23
1144474768 Jennifer K Workman Pediatrics 100 N Mario Capecchi Drive, Pediatric Crtical Care, Primary Children's Hospital, Salt Lake City, UT 84113 2008-11-10
1588634729 William Bradley Poss Pediatrics 295 E Chipeta Way, Salt Lake City, UT 84108-1287 2006-01-23
1174056758 Andrew Daniel Fontes Pediatrics 295 S Chipeta Way, Salt Lake City, UT 84108-1287 2017-04-10
1457883449 Lauren Burgunder Pediatrics 295 S Chipeta Way, Salt Lake City, UT 84108-1287 2017-03-30
1376907410 University of Utah Pediatric Acuity Care Pediatrics 3741 W 12600 S, Riverton, UT 84065-7215 2016-04-05
1891156741 University of Utah Pediatric Acuity Care Pediatrics 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 2016-03-18
1669866133 Angela Coker Pediatrics 295 S Chipeta Way, Salt Lake City, UT 84108 2015-03-23
1801216957 Kevin Hummel Pediatrics 30 N 1900 E # 1c412, Salt Lake City, UT 84132-9760 2014-04-16
1972842813 Tighe Nicholas Marrone Pediatrics 295 S Chipeta Way, Salt Lake City, UT 84108-1287 2013-02-13
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Competitor

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City PROVO
Zip Code 84604

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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