| Summit Medical Care | |
|
777 N 500 W Ste 103 Provo UT 84601-1552 | |
| (801) 253-6886 | |
| (801) 253-6888 |
| Full Name | Summit Medical Care |
|---|---|
| Speciality | Family Medicine |
| Location | 777 N 500 W Ste 103, Provo, Utah |
| Authorized Official Name and Position | Ryan Ellsworth (OWNER) |
| Authorized Official Contact | 8015500955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Medical Care 9980 S 300 W Ste 310 Sandy UT 84070-3654 Ph: (801) 253-6886 | Summit Medical Care 777 N 500 W Ste 103 Provo UT 84601-1552 Ph: (801) 253-6886 |
| NPI Number | 1881216646 |
|---|---|
| Provider Enumeration Date | 05/14/2020 |
| Last Update Date | 05/18/2022 |
| Medicare PECOS PAC ID | 7416345673 |
|---|---|
| Medicare Enrollment ID | O20211021000925 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881216646 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | James L Clark |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194731323 PECOS PAC ID: 9133151756 Enrollment ID: I20050903000010 |
| Provider Name | Ryan Scott Ellsworth |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1104130574 PECOS PAC ID: 3678719135 Enrollment ID: I20130429000536 |
| Provider Name | Landon T Cameron |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1598119463 PECOS PAC ID: 4082900949 Enrollment ID: I20160901002281 |
| Provider Name | Leslee Ronald Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083082283 PECOS PAC ID: 0648570804 Enrollment ID: I20160919001270 |
| Provider Name | Todd Joseph Jaramillo |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1215315817 PECOS PAC ID: 5395054464 Enrollment ID: I20180605001657 |
| Provider Name | Carolyn Louise Krenkel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295700698 PECOS PAC ID: 2769407790 Enrollment ID: I20190927000739 |
| Provider Name | Braden Brklacich |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1609397207 PECOS PAC ID: 9739594037 Enrollment ID: I20210218002724 |
| Provider Name | Adam Dicks |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1780047936 PECOS PAC ID: 0042541740 Enrollment ID: I20210220000107 |
| Provider Name | Jordan Radandt |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1053801324 PECOS PAC ID: 8426459587 Enrollment ID: I20210625002406 |
| Provider Name | Nancy T Pourkaram |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1790762573 PECOS PAC ID: 0749182483 Enrollment ID: I20220113002562 |
| Provider Name | Boyd Andrews |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1720333792 PECOS PAC ID: 7113233735 Enrollment ID: I20220114000982 |
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