salt lake orthopaedic clinic – Specialist, NPI 1811913429
Specialist
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for salt lake orthopaedic clinic
1160, 3900 South, Millcreek, Salt Lake County, Utah, 84124, United States
SUITE 5000
SALT LAKE CITY, UT 841241202
Phone: (801) 262-8486
Fax: (801) 262-9752
Type: Location
280 S MAIN ST
BOUNTIFUL, UT 840106236
Phone: (801) 505-0821
Fax: (801) 505-0803
Type: Mailing
2326 N 400 E Ste 102
Tooele, UT 840743460
Phone: (435) 241-6444
Fax: (435) 615-8823
Type: Location
1521 E 3900 S STE 200
SALT LAKE CITY, UT 841241501
Phone: (801) 262-8486
Fax: (801) 284-8699
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2010-09-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-08-31 (287 days ago).
Enrollment records
2
Earliest due date
2025-08-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040102000837 | O | Clinic/Group Practice | UT | TBD |
| O20100930048470 | O | Physician - Orthopedic/Orthopedic Surgery | UT | 2025-08-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 84124)
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