JUPITER MEDICAL I LLC (NPI# 1104346543) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104346543 |
| Entity Type | Organization |
| Organization Name | JUPITER MEDICAL I LLC |
| Practice Address |
1784 Uinta Way Unit E2 Park City UT 84098-7685 |
| Mailing Address |
21 White Hill Rd Cold Spring Harbor NY 11724-1211 |
| Practice Telephone | 4356040160 |
| Practice Fax Number | 4357318328 |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2017-06-27 |
| Authorized Official Name | MR. BRYAN KNEPPER (OWNER) |
| Authorized Official Telephone | 6175713680 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | UT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | U000092310 | 05 |
| Street Address |
1784 UINTA WAY UNIT E2 |
| City | PARK CITY |
| State | UT |
| Zip Code | 84098-7685 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144777418 | Kevin Bryan James Huntington | Physician Assistant | 1784 Uinta Way Unit E2, Park City, UT 84098-7685 | 2016-09-05 |
| 1891303202 | Alexa Nicole Aubin | Nurse Practitioner | 1784 Uinta Way Unit E2, Park City, UT 84098-7685 | 2020-07-21 |
| 1164063277 | Stat-md I | Internal Medicine | 1784 Uinta Way Unit E2, Park City, UT 84098-7685 | 2019-10-01 |
| 1518519859 | Allison E Mayzel | Physician Assistant | 1784 Uinta Way Unit E2, Park City, UT 84098-7685 | 2019-07-16 |
| 1518447648 | Carrie Jennifer Welter | Nurse Practitioner | 1784 Uinta Way Unit E2, Park City, UT 84098-7685 | 2018-08-17 |
| 1912407180 | Matthew Paul | Physician Assistant | 1784 Uinta Way Unit E2, Park City, UT 84098-7685 | 2018-02-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972069532 | Natasha Nicolle Peterson | Nurse Practitioner | Stat Md, 1784 Uinta Way E, Park City, UT 84098 | 2019-02-19 |
| 1750732079 | Rebecca Hansen | Physical Therapist | 1640 W Redstone Center Dr, Suite 200, Park City, UT 84098 | 2016-06-28 |
| 1497126130 | Megan Franz | Counselor | 3100 Pinebrook Rd, Park City, UT 84098 | 2015-10-07 |
| 1568752541 | Kortney James Stirland | Pharmacist | 750 Round Valley Drive #203, Park City, UT 84098 | 2011-04-12 |
| 1265763379 | Amy S Koch | Physical Therapy Assistant | 1640 West Redstone Drive, Suite 200, Park City, UT 84098 | 2010-01-29 |
| 1134374648 | Donna B Fischer | General Practice | 6531 N Landmark Dr., Park City, UT 84098 | 2008-11-25 |
| 1962659458 | Patricia A Lindsay Phd Inc | Psychologist | 1743 W Redstone Ctr Dr, #115, Park City, UT 84098 | 2008-08-26 |
| 1437314291 | Jeffrey S Holverson | Internal Medicine | 6240 N Snowview Dr, Park City, UT 84098 | 2008-07-22 |
| 1578728515 | Blair Archbold Smith | Physical Therapist | 6880 Canyon Drive Court, Park City, UT 84098 | 2008-07-18 |
| 1821255274 | Beth Anita Rylands | Physical Therapy Assistant | 1640 W. Redstone Center Dr., Suite 200, Park City, UT 84098 | 2008-05-21 |
| Find all providers in zip 84098 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| 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 Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528352721 | Michael Aaron Kagen | Internal Medicine | 4580 Silver Springs Dr Ste 150, Park City, UT 84098-6198 | 2011-06-06 |
| 1942441068 | Robert Eugene Pellegrine | Internal Medicine | 2009 Mahre Dr, Park City, UT 84098-8510 | 2009-03-19 |
| 1437314291 | Jeffrey S Holverson | Internal Medicine | 6240 N Snowview Dr, Park City, UT 84098 | 2008-07-22 |
| 1578675708 | Sheila Varghese Maliekel | Internal Medicine | 401 Greenleaf St, Suite One, Park City, IL 60085-5744 | 2006-09-01 |
| 1497712376 | Kim Ellen Scott | Internal Medicine | 1777 Sun Peak Dr, Suite 150, Park City, UT 84098-6725 | 2006-04-26 |
| 1407812613 | Kim Scott Md Plc | Internal Medicine | 1790 Sun Peak Dr, Suite A101, Park City, UT 84098-6559 | 2006-04-25 |
| 1881661148 | Yusuf Qamar | Internal Medicine | 1755 E 61st St. N., Park City, KS 67219-1917 | 2006-03-07 |
| 1164063277 | Stat-md I | Internal Medicine | 1784 Uinta Way Unit E2, Park City, UT 84098-7685 | 2019-10-01 |
| 1306394929 | Ihc Health Services Inc | Internal Medicine | 1493 Lowell Ave, Park City, UT 84060-5116 | 2016-09-12 |
| 1699060079 | David Nathan Burrow | Internal Medicine | 750 Round Valley Dr Ste 201, Park City, UT 84060 | 2011-06-14 |
| Find all providers in PARK CITY | ||||
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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.