KURT O BODILY (NPI# 1780600312) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780600312 |
| Entity Type | Individual |
| Full Name | KURT O BODILY |
| Credential | MD |
| Practice Address |
1055 N 500 W Ste 100 Provo UT 84604-3305 |
| Mailing Address |
1055 N 500 W Attn: Credentialing Provo UT 84604-3305 |
| Practice Telephone | 8013741268 |
| Practice Fax Number | 8018125454 |
| Mailing Telephone | 8013548225 |
| Mailing Fax Number | 8014180941 |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2020-06-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
322494-1205 | UT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | UNITED HEALTHCARE | 29-00038 | 01 |
| UT | PEHP | 39508 | 01 |
| UT | EMIA | 870281028BO2 | 01 |
| PALMETTO | 100009090 | 01 | |
| UT | IHC | 107007621101 | 01 |
| UT | DMBA | 265465 | 01 |
| UT | ALTIUS | QM0000009163 | 01 |
| Street Address |
1055 N 500 W STE 100 |
| City | PROVO |
| State | UT |
| Zip Code | 84604-3305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477971281 | Adam Toller | Physician Assistant | 1055 N 500 W Ste 100, Provo, UT 84604-3305 | 2014-03-31 |
| 1770825713 | Brandon Thomas Dickinson | Internal Medicine | 1055 N 500 W Ste 100, Provo, UT 84604-3305 | 2013-03-17 |
| 1740514892 | Daniel Ibarra-taylor | Physician Assistant | 1055 N 500 W Ste 100, Provo, UT 84604-3305 | 2009-09-22 |
| 1962654681 | Chad Barrett Kawa | Internal Medicine | 1055 N 500 W Ste 100, Provo, UT 84604-3305 | 2008-10-13 |
| 1124286133 | Bryce Donald Haslem | Family Medicine | 1055 N 500 W Ste 100, Provo, UT 84604-3305 | 2008-05-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346882107 | Abigail Belle Hardy | Student in an Organized Health Care Education/Training Program | 1190 900 E, Provo, UT 84604 | 2019-10-14 |
| 1386106698 | Sarah Roseman Hunt | Nurse Practitioner | 1055 N 500 W., Suite. 101, Bldg. C, Provo, UT 84604 | 2019-04-04 |
| 1255813325 | Hwigeum Jeong | Specialist/Technologist | Department of Exercise Sciences 106 Sfh Brigham Young, Provo, UT 84604 | 2018-09-05 |
| 1093203044 | Snowcap Smile Studio LLC | Dentist | 2230 N. University Pkwy Ste 8b, Provo, UT 84604 | 2018-04-25 |
| 1407359078 | Ihc Health Services Inc | Clinic/Center | 380 W Bulldog Blvd, Ste 403, Provo, UT 84604 | 2018-03-09 |
| 1902308455 | Afton Leuga | Nurse Practitioner | 395 W Bulldog Blvd., Suite 401, Provo, UT 84604 | 2018-03-01 |
| 1851807333 | Ihc Health Services Inc | Family Medicine | 380 W 1230 N, Ste 602, Provo, UT 84604 | 2017-12-20 |
| 1689180218 | Ihc Health Services Inc | Pediatrics | 395 W Bulldog Blvd Ste 703, Provo, UT 84604 | 2017-12-19 |
| 1396254165 | Nicolas Sorensen | Massage Therapist | 247 West 2230 North #201, Provo, UT 84604 | 2017-09-25 |
| 1437692241 | Cirque Lodge Inc | Substance Abuse Rehabilitation Facility | 3114 E Ida's Road, Sundance, UT 84604 | 2016-11-28 |
| Find all providers in zip 84604 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal 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 |
|---|---|---|---|---|
| 1770825713 | Brandon Thomas Dickinson | Internal Medicine | 1055 N 500 W Ste 100, Provo, UT 84604-3305 | 2013-03-17 |
| 1962432583 | Brett L Thorpe | Internal Medicine | 1055 N 500 W, Suite 100 Bldg B, Provo, UT 84604-3305 | 2006-07-03 |
| 1124077391 | Gregory E Craner | Internal Medicine | 1055 N 500 W, Suite 100 Bldg B, Provo, UT 84604-3305 | 2006-05-08 |
| 1376591354 | Thomas A Dickinson | Internal Medicine | 1055 N 500 W, Suite 100 Bldg B, Provo, UT 84604-3305 | 2006-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447662523 | Utah Gastroenterology P C | Internal Medicine | 74 E Kimball Lane, Suite 230, Draper, UT 84020-7735 | 2014-05-23 |
| 1992066799 | Brien Rex Miller | Internal Medicine | 368 E Riverside Dr Ste A, St George, UT 84790-6897 | 2012-06-07 |
| 1881928794 | Tranquil Living Center Group Corp | Internal Medicine | 189 N Highway 89, Ste C-10, N Salt Lake, UT 84054-2432 | 2009-09-24 |
| 1568592590 | Ihc Health Services Inc | Internal Medicine | 374 10th Ave, Suite 100, Salt Lake City, UT 84103-2823 | 2007-03-07 |
| 1306925433 | Robert F Miller | Internal Medicine | 1002 East South Temple, Ste 412, Salt Lake City, UT 84102 | 2006-11-02 |
| 1033209622 | Randall W. Burt | Internal Medicine | Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112 | 2006-10-13 |
| 1871689562 | Utah Gastroenterology P C | Internal Medicine | 1187 E 3900 S, Salt Lake City, UT 84124-1201 | 2006-10-04 |
| 1922113380 | Robert Shigeru Kiyomura | Internal Medicine | 2084 Robins Dr, Suite B, Layton, UT 84041-1100 | 2006-08-19 |
| 1760491054 | Vikram Garg | Internal Medicine | 1300 N 500 E Ste 340, Logan, UT 84341-2470 | 2006-08-05 |
| 1972510717 | Utah Gastroenterology P C | Internal Medicine | 6360 South 3000 East, Suite 310, Salt Lake City, UT 84121 | 2006-08-02 |
| 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.