PHYSICIAN MEDICAL GROUP (NPI# 1972078723) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972078723 |
| Entity Type | Organization |
| Organization Name | PHYSICIAN MEDICAL GROUP |
| Other Organization Name | EVOLVE MEDICAL |
| Practice Address |
4624 S Holladay Blvd Ste 202 Salt Lake City UT 84117-7168 |
| Practice Telephone | 3858005015 |
| Practice Fax Number | 8012776678 |
| Mailing Telephone | 8018102999 |
| Mailing Fax Number | 8014070747 |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2020-02-12 |
| Authorized Official Name | JENNY SIMBARI (BILLER) |
| Authorized Official Telephone | 3858005015 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | GROUP NPI | 1972078723 | 01 |
| UT | INDIVIDUAL NPI | 1740543834 | 01 |
| UT | INDIVIDUAL NPI | 1184807208 | 01 |
| UT | INDIVIDUAL NPI | 1356897821 | 01 |
| UT | INDIVIDUAL NPI | 1619935053 | 01 |
| UT | INDIVIDUAL NPI | 1861622219 | 01 |
| Other Name | Type Code |
|---|---|
| Evolve Medical | Doing Business As Name - Organization |
| Street Address |
4624 S HOLLADAY BLVD STE 202 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84117-7168 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568965697 | Comprehensive Interventional Care Centers, Pllc | Radiology | 4624 S Holladay Blvd Ste 202, Salt Lake City, UT 84117-7168 | 2018-03-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063052256 | Abundant Dental Care, P.C. | Dentist | 1548 E 4500 S #104, Holladay, UT 84117 | 2020-01-15 |
| 1578127221 | Signature Utah Dental Partners PC | Clinic/Center | 2240 E Murray Holladay Rd, Holladay, UT 84117 | 2019-04-29 |
| 1700392974 | Marette Monson, LLC | Community/Behavioral Health | 2180 East 4500 South, Suite 105, Holladay City, UT 84117 | 2017-12-23 |
| 1942714639 | Harmon City Inc | Pharmacy | 4675 South Holladay Blvd, Holladay, UT 84117 | 2017-11-17 |
| 1881119444 | Brianna Stewart | Physical Medicine & Rehabilitation | 5151 South 900 East, Suite 100, Salt Lake City, UT 84117 | 2017-08-04 |
| 1861842874 | Whitney Aste | Dentist | 1548 E 4500 S Ste 104, Salt Lake City, UT 84117 | 2016-06-21 |
| 1922403765 | Tri-peak, Pllc | Psychologist | 4535 S 2300 E, Suite B, Salt Lake City, UT 84117 | 2014-10-22 |
| 1356689566 | Mckenzie Vierig | Marriage & Family Therapist | 4568 S Highland Dr Ste 380, Millcreek, UT 84117 | 2013-01-22 |
| 1821348640 | Fabiola Marquez Jamieson | Social Worker | 4500 S 2180 E, Suite 165, Holladay, UT 84117 | 2012-09-19 |
| 1073882882 | Amy Rose White | Social Worker | 4500 South 2180 East, Suite 165, Holladay, UT 84117 | 2011-12-22 |
| Find all providers in zip 84117 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558905398 | Wasatch Vascular Center LLC | Radiology | 3702 S State St Ste 103, Salt Lake City, UT 84115-5096 | 2019-11-05 |
| 1568965697 | Comprehensive Interventional Care Centers, Pllc | Radiology | 4624 S Holladay Blvd Ste 202, Salt Lake City, UT 84117-7168 | 2018-03-15 |
| 1356630073 | Claire Kaufman | Radiology | Medical Center 30 N 1900 E, Salt Lake City, UT 84132-0001 | 2011-04-04 |
| 1821154121 | Ryan Gene O'hara | Radiology | University of Utah Dept of Radiology, 30n. 1900e #1a071, Salt Lake City, UT 84132-6100 | 2006-12-29 |
| 1386731339 | Franklin J. Miller Jr. | Radiology | Dept Radiology University of Utah 50 N Medical Drive, 1a71, Salt Lake City, UT 84132-0001 | 2006-10-09 |
| 1104361591 | Genesis Vascular of Salt Lake | Radiology | 6321 S Redwood Rd, Suite 102, Salt Lake City, UT 84123-6798 | 2016-12-21 |
| 1457755258 | University of Utah Adult Services | Radiology | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2014-10-22 |
| 1184044190 | Kevin Maxwell | Radiology | 1200 E 3900 S, Salt Lake City, UT 84124-1300 | 2014-04-17 |
| 1316203797 | Jared Randall Garrett | Radiology | 30 N 1900 E Rm 1a071, Salt Lake City, UT 84132-0002 | 2012-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679180509 | Provas of Provo | Radiology | 320 River Park Dr Ste 215, Provo, UT 84604-6065 | 2020-09-24 |
| 1831662311 | Cache Valley Vein | Radiology | 565 W 465 N Ste 130, Providence, UT 84332-4802 | 2019-01-07 |
| 1740608272 | Michael Max Adam | Radiology | 1055 N 500 W Ste 112, Provo, UT 84604-3305 | 2014-04-02 |
| 1982821690 | Edward John Sarver | Radiology | 5395 Old Post Rd, Ogden, UT 84403-4346 | 2007-04-20 |
| 1790736130 | St. George Radiology Inc. | Radiology | 1308 E 900 S, St George, UT 84790-8520 | 2006-05-12 |
| 1073170031 | Provas of Ogden, LLC | Radiology | 5974 Fashion Point Dr Ste 110, South Ogden, UT 84403-4712 | 2019-05-24 |
| 1407410244 | Provas of Salt Lake, LLC | Radiology | 909 E 9400 S, Sandy, UT 84094-5514 | 2019-04-26 |
| 1265483598 | Utah Valley Radiology Associates Inc | Radiology | 1034 N 500 W, Provo, UT 84604-3380 | 2006-05-12 |
| City | SALT LAKE CITY |
| Zip Code | 84117 |
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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.