EVAN K. DAUGHERTY (MD) – Internal Medicine Physician, NPI 1487117198

EVAN K. DAUGHERTY (MD) is a healthcare provider. based in Salt lake city, Utah. specializing in GASTROENTEROLOGY. They hold the professional credentials MD. They hold a License No. 11885540-1205 (UT). The NPI Number for EVAN K. DAUGHERTY (MD) is 1487117198

Main info

Male
4 Years Of Experience
Accepts Medicare Assignment
Name
EVAN K. DAUGHERTY (MD)
NPI
1487117198
Phone
(801) 581-7606
Address
30 N 1900 E RM 4C116
Enumeration Date
9 April 2019
Last Update Date
13 August 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
2022 (4 years ago)
PAC ID
5597183293
Group Practice PAC ID
5496653230
Professional Enrollment ID
I20250822001220
Address ID
NM875054781Sa1691XSTXX301
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience38
Completeness75
Years active:7State licenses:1Digital endpointsOther names

137 GASTROENTEROLOGY in UT

Provider Addresses for EVAN K. DAUGHERTY (MD)

  • 30 N 1900 E RM 4C116

    SALT LAKE CITY, UT 841320002

    Phone: (801) 581-7606

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 216 Open Payments records for all available years, with a total value of $4,455.

Total Amount is formed as General ($4,455) + Research ($0) + Ownership ($0) = $4,455.

Last reported payment date: 2024-12-31 • Largest payer in this snapshot: Salix Pharmaceuticals, a division of Bausch Health US, LLC ($714).

Total Amount

$4,455

General + Research + Ownership

Payments

216

Total payment records

General Amount

$4,455

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-31

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-08-22

PECOS data refreshed: 2026-06-15

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250822001220IGastroenterologyNMTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 84132)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5496653230View full group profile
NameSpecialtyState
Physician AssistantNM
-NM
G A S T R O E N T E R O L O G YNM
G A S T R O E N T E R O L O G YNM
G A S T R O E N T E R O L O G YLA
G A S T R O E N T E R O L O G YNM
G A S T R O E N T E R O L O G YNM
Nurse PractitionerNM
Nurse PractitionerNM
-NM

Reviews

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Frequently asked questions

What unique ID ties claims to EVAN K. DAUGHERTY (MD)?
NPI 1487117198 is assigned to EVAN K. DAUGHERTY (MD) under the national enumeration system.
Does this profile mean EVAN K. DAUGHERTY (MD) is currently active?
Yes — EVAN K. DAUGHERTY (MD) appears active in the national provider directory.
What kind of provider is EVAN K. DAUGHERTY (MD)?
The page reflects Internal Medicine Physician for EVAN K. DAUGHERTY (MD). Clinical services aligned with this taxonomy classification.
What location shows for EVAN K. DAUGHERTY (MD)?
We surface Salt Lake City, Utah for EVAN K. DAUGHERTY (MD) based on available NPPES addresses.
What if Salt Lake City, Utah seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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