UNIVERSITY PRIMARY CARE SPORTS MED (NPI# 1699796706) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699796706 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY PRIMARY CARE SPORTS MED |
| Practice Address |
555 Foothill Dr Salt Lake City UT 84112-1106 |
| Mailing Address |
Po Box 510004 Salt Lake City UT 84151-0004 |
| Practice Telephone | 8015855382 |
| Mailing Telephone | 8015876303 |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2011-09-06 |
| Authorized Official Name | DR. MICHAEL K MAGILL (DEPARTMENT CHAIR) |
| Authorized Official Telephone | 8015855382 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NV | NEVADA MEDICAID | 100510167 | 01 |
| ID | IDAHO MEDICAID | 807551900 | 01 |
| WY | WYOMING MEDICAID | 123613000 | 01 |
| UT | RAILROAD MEDICARE | DG1456 | 01 |
| Street Address |
555 FOOTHILL DR |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84112-1106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801887757 | Vicky Y. Digregorio | Pharmacist | 555 Foothill Dr, Madsen Health Center, Internal Medicine, Salt Lake City, UT 84112-1106 | 2005-10-31 |
| 1699382986 | University of Utah Behavioral Health Services | Social Worker | 555 Foothill Dr, Salt Lake City, UT 84112-1106 | 2020-09-30 |
| 1922611961 | Joseph Eli Bergen | Pharmacist | 555 Foothill Dr, Salt Lake City, UT 84112-1106 | 2020-08-28 |
| 1346872017 | Sharee Thompson | Dietitian, Registered | 555 Foothill Dr, Salt Lake City, UT 84112-1106 | 2020-02-10 |
| 1285275222 | Deanna Marszalek | Psychologist | 555 Foothill Dr, Salt Lake City, UT 84112-1106 | 2019-10-01 |
| 1326695990 | Emogene Elizabeth Dunn | Social Worker | 555 Foothill Dr, Salt Lake City, UT 84112-1106 | 2019-08-19 |
| 1558925149 | Vanessa Browning | Dietitian, Registered | 555 Foothill Dr, Salt Lake City, UT 84112-1106 | 2019-04-29 |
| 1669935524 | Mauli R. Dalal | Family Medicine | 555 Foothill Dr, Salt Lake City, UT 84112-1106 | 2019-04-08 |
| 1316409097 | Joseph J. Novak | Family Medicine | 555 Foothill Dr, Salt Lake City, UT 84112-1106 | 2019-04-02 |
| 1033616602 | Sherilyn M Destefano | Family Medicine | 555 Foothill Dr, Salt Lake City, UT 84112-1106 | 2018-04-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508484023 | Courtney Hook | Student in an Organized Health Care Education/Training Program | 1860 E 250 S Hper East, Room 208, Salt Lake City, UT 84112 | 2020-07-10 |
| 1235792839 | Dylan Lamb | Rehabilitation Practitioner | 1850 S. 260 E, Salt Lake City, UT 84112 | 2019-04-18 |
| 1740787407 | David Bradley Patch | Student in an Organized Health Care Education/Training Program | University of Utah Hospital Dental Clinic #7, 50 N. Medical Dr., Salt Lake City, UT 84112 | 2018-04-10 |
| 1962949586 | Gina Whitehead | Nurse Practitioner | 10 South 2000 East, Salt Lake City, UT 84112 | 2017-01-20 |
| 1316493117 | Dana Friske | Specialist/Technologist | 290 S 1850 E, Room 103, Salt Lake City, UT 84112 | 2016-08-31 |
| 1548612435 | Frances Millett Johnson | Nurse Practitioner | 555 South Foothill Blvd, Suite 301, Salt Lake City, UT 84112 | 2016-07-05 |
| 1679920904 | Jason Lippman | Family Medicine | 555 S. Foothill Blvd., Ste. 301, Salt Lake City, UT 84112 | 2016-05-17 |
| 1447604335 | Joseph Mcbeth | Specialist/Technologist | 580 S. Guardsman Way, Salt Lake City, UT 84112 | 2016-04-18 |
| 1104213636 | Cameron Critchfield | Student in an Organized Health Care Education/Training Program | 26 South 2000 East, Suite 5900, Salt Lake City, UT 84112 | 2015-04-22 |
| 1942697933 | Jennifer Rose | Dentist | 50 N Medical Dr, University Hospital, Salt Lake City, UT 84112 | 2015-04-17 |
| Find all providers in zip 84112 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164826665 | University of Utah Adult Services | Family Medicine | 555 Foothill Dr, Salt Lake City, UT 84112-1106 | 2014-10-14 |
| 1508009929 | David Matthew Ziegler | Family Medicine | 590 S Wakara Way, Salt Lake City, UT 84108-1200 | 2009-04-15 |
| 1427022938 | Leslie Hardin Rassner | Family Medicine | 1250 E 3900 S, Suite 260, Salt Lake City, UT 84124-1348 | 2006-02-14 |
| 1740270867 | Laura M Anderson | Family Medicine | 1525 W 2100 S, Salt Lake City, UT 84119-1401 | 2005-10-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053702431 | Weber State University | Family Medicine | 1001 University Cir, Ogden, UT 84408-5525 | 2015-02-06 |
| 1720169915 | Stuart Eliot Willick | Family Medicine | 1493 Lowell Ave, Park City, UT 84060 | 2006-10-17 |
| 1043210248 | Trek Lyons | Family Medicine | 1300 N 500 E, Suite 130, Logan, UT 84341-2408 | 2005-07-28 |
| 1316323165 | Dixie State University | Family Medicine | 225 S 700 E, St George, UT 84770-3875 | 2015-08-04 |
| 1285013987 | Sportsmed Associates LLC | Family Medicine | 3401 N Center St, Ste 100, Lehi, UT 84043-7497 | 2015-05-27 |
| 1164860573 | Brett Wayne Martindale | Family Medicine | 4700 Harrison Blvd, Ogden, UT 84403-4303 | 2013-06-07 |
| 1053631069 | Tye Harrison | Family Medicine | 1350 N 500 E, Logan, UT 84341-2400 | 2010-06-02 |
| 1720303837 | Nicholas E Monson | Family Medicine | 2132 N 1700 W, 230, Layton, UT 84041-7057 | 2010-03-31 |
| 1346478476 | Ryan Albert Slater | Family Medicine | 1184 E 80 N, American Fork, UT 84003-2906 | 2009-06-26 |
| 1922232867 | Christopher R. Gordon | Family Medicine | 1157 N 300 W, Provo, UT 84604-6124 | 2009-05-06 |
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| City | SALT LAKE CITY |
| Zip Code | 84112 |
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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.