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).
| 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 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
7365706-1205 | UT | Allopathic & Osteopathic Physicians |
| Street Address |
1034 N 500 W |
| City | PROVO |
| State | UT |
| Zip Code | 84604-3380 |
| 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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| 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 |
| Find all providers in zip 84604 | ||||
| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| 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) |
| 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 |
| 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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| 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.