BLUE SAGE MEDICAL LLC (NPI# 1487016226) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487016226 |
| Entity Type | Organization |
| Organization Name | BLUE SAGE MEDICAL LLC |
| Practice Address |
6300 Sagewood Dr Suite H-532 Park City UT 84098-7502 |
| Practice Telephone | 8017187280 |
| Practice Fax Number | 8888535162 |
| Mailing Telephone | 8017187280 |
| Mailing Fax Number | 8888535162 |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2017-08-29 |
| Authorized Official Name | GINA COCCIMIGLIO (AGPCNP) |
| Authorized Official Telephone | 8017187280 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
123071-4405 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
6300 SAGEWOOD DR SUITE H-532 |
| City | PARK CITY |
| State | UT |
| Zip Code | 84098-7502 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184996084 | Edna Ann Cooper | Occupational Therapy Assistant | 6300 Sagewood Dr, Suite H423, Park City, UT 84098-7502 | 2012-02-08 |
| 1255757845 | Ariel Ford | Psychologist | 6300 Sagewood Dr, #434, Park City, UT 84098-7502 | 2014-03-06 |
| 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 | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104487677 | Brandilyn Rolfe | Nurse Practitioner | 2629 Cottage Ct, Park City, UT 84098-8226 | 2019-06-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235742016 | Luz Elena Reni | Nurse Practitioner | 593 Millcreek Way, Bountiful, UT 84010-3920 | 2020-08-31 |
| 1841803137 | Anywhere Care | Nurse Practitioner | 9980 S. 300 W. Suite 200, Sandy, UT 84070 | 2020-08-26 |
| 1356952840 | Sandra Robles | Nurse Practitioner | 6671 S Redwood Rd Ste 101, West Jordan, UT 84084-7489 | 2020-08-10 |
| 1265050660 | Dana Michelle Roach | Nurse Practitioner | 3435 E Pony Express Pkwy Ste 104, Eagle Mountain, UT 84005-5515 | 2020-07-12 |
| 1174141964 | Kaitlyn Miller Albrecht | Nurse Practitioner | 14094 S Candy Pull Dr, Draper, UT 84020-7511 | 2020-07-08 |
| 1700403540 | Brady Ardell Byington | Nurse Practitioner | 6654 Willow Creek Rd, Mountain Green, UT 84050-6810 | 2020-06-27 |
| 1528697950 | Meagan Mckean | Nurse Practitioner | 2486 E Newport Cir, Cottonwood Heights, UT 84121-5642 | 2020-04-07 |
| 1447819974 | Andrew Brice Heinecke | Nurse Practitioner | 6807 S 3200 W, West Jordan, UT 84084-1828 | 2019-06-09 |
| 1467977884 | Eden Family Care and Medical Aesthetics | Nurse Practitioner | 2612 N Highway 162, Eden, UT 84310-9745 | 2017-08-07 |
| 1124499769 | Gunnison Valley Hospital | Nurse Practitioner | 131 E Main St # 3, Salina, UT 84654-1335 | 2015-10-08 |
| Find all providers with the same taxonomy | ||||
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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.