EVAN A. CROCKETT MD
NPI 1093448607
Urology in Salt Lake City, UT

Q: What is Evan Crockett's NPI number?

The NPI number for Evan Crockett is 1093448607. It was assigned to this individual provider in the NPPES registry on July 1, 2022.

Q: What is Evan Crockett's specialty?

The primary specialty registered for this NPI is Urology with taxonomy code 208800000X.

Q: When was this NPI record last updated?

The NPPES record for Evan Crockett was last updated on August 22, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 01, 2022PECOS Enrolled

30 N MARIO CAPECCHI DR RM 4S100, SALT LAKE CITY, UT 84112(801) 581-2121 Get Directions Write a Review

NPPES record last updated: August 22, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Evan A. Crockett Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EVAN A. CROCKETT MD (NPI 1093448607) is an individual urology provider in Salt Lake City, Utah, licensed in Utah (13548246-1205) and active in the NPI registry since July 2022. He is enrolled in Medicare PECOS and maintains a secondary practice location in Fort Sam Houston.

NPPES Registry Identity

NPI1093448607

Entity TypeIndividualMale

Primary Taxonomy208800000X

Provider Legal NameEVAN A. CROCKETTCredential: MD

Location Address30 N MARIO CAPECCHI DR RM 4S100Salt Lake City, UT 84112

Mailing Address30 N Mario Capecchi Dr Rm 4s100Salt Lake City, UT 84112 · (801) 581-2121

Phone(801) 581-2121

Sole ProprietorNo

Enumeration DateJuly 1, 2022

Last NPPES UpdateAugust 22, 2023

NPPES CertifiedJanuary 17, 2023

✔ NPI 1093448607 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyUrologyAllopathic & Osteopathic Physicians

Taxonomy Code208800000X

License✔ Licensed in UT · 13548246-1205

Definition

A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

Also ListedSurgeryTaxonomy 208600000X · License BP10080668 (TX)

30 N MARIO CAPECCHI DR RM 4S100, Salt Lake City, UT 84112

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Secondary Practice Location 1

Location 13551 Roger Brooke Dr Bldg 3600Fort Sam Houston, TX 78234-4504 · Phone (907) 310-6267

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Evan A. Crockett Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84112 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$125.70 typical visit price

range $54.34 – $166.03

Typical copayment $31.42 (range $13.58 – $41.50)

Most-billed visit code 99204

Established Patient

$68.01 typical visit price

range $17.23 – $135.20

Typical copayment $17.00 (range $4.30 – $33.80)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALEXANDER SCHURMAN

Surgery (Vascular Surgery)