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DAVID CROCKETT
NPI 1104351592
Emergency Medicine in Salt Lake City, UT

Active since April 24, 2017PECOS EnrolledAccepts Medicare Assignment
92.06/100
CMS Quality Rating
UNIVERSITY OF UTAH SCHOOL OF MEDICINE 30 N 1900 E 1C026, SALT LAKE CITY, UT 84132(801) 581-2417 Get Directions Write a Review

NPPES record last updated: November 12, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Nov 12, 2021, Jul 1, 2020, Apr 7, 2020 and 2 more (5 updates tracked since 2017).

About David Crockett NPPES

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

DAVID CROCKETT (NPI 1104351592) is an individual emergency medicine provider in Salt Lake City, Utah, licensed in Utah (11680436-1205) and active in the NPI registry since April 2017. He is enrolled in Medicare PECOS, is affiliated with Holy Cross Hospital - Salt Lake, and maintains a secondary practice location in Chattanooga.

NPPES Registry Identity

NPI1104351592
Entity TypeIndividualMale
Primary Taxonomy207P00000X
Provider Legal NameDAVID CROCKETT
Location AddressUNIVERSITY OF UTAH SCHOOL OF MEDICINE 30 N 1900 E 1C026Salt Lake City, UT 84132-2147
Mailing Address975 E 3rd St, Att: Velvet Green, Program Coordinator Em ResidencyChattanooga, TN 37403-2147 · (423) 778-7673
Phone(801) 581-2417
Sole ProprietorNo
Medical School CMSOtherGraduated 2017
Enumeration DateApril 24, 2017
Last NPPES UpdateNovember 12, 20215 updates tracked since enumeration
NPPES CertifiedNovember 12, 2021
✔ NPI 1104351592 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
Licenses✔ Licensed in UT · 11680436-1205✔ Licensed in TN · 59020
Definition
An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
UNIVERSITY OF UTAH SCHOOL OF MEDICINE 30 N 1900 E 1C026, Salt Lake City, UT 84132
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Secondary Practice Location 1

Location 1975 E 3rd St, ATT: Velvet Green, Program Coordinator EM ResidencyChattanooga, TN 37403-2147 · Phone (423) 778-7673

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Wyoming.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

David Crockett is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6709163132
PECOS Enrollment IDI20200601002227, I20200715000910
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.

Medicare Billing Reassignments

4

Medicare enrollment records show David Crockett reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

University Of Utah Adult Services
0.8 mi
Otolaryngology
50 N MEDICAL DR
Salt Lake City, UT 84132
  • Reassigned Medicare billing, Utah and Wyoming enrollments
  • Also billed through NPI 1174033989 (Wyoming)
  • 2,620 clinicians in this Medicare group
NPI 1003210808 (801) 587-6336
Dhhs, Phs, Naihs, Shiprock Hospital
303 mi
General Acute Care Hospital
US HWY 160 & NAVAJO ROUTE 35 - RED MESA
Teecnospos, AZ 86514
  • Reassigned Medicare billing, Texas enrollment
  • 572 clinicians in this Medicare group
NPI 1477615789 (505) 368-6401
Dhhs Ihs Phoenix Area
351 mi
Critical Access
HIGHWAY 264 MILEPOST 388
Polacca, AZ 86042
  • Reassigned Medicare billing, Texas enrollment
  • 199 clinicians in this Medicare group
NPI 1356628028 (928) 737-6000
Tennessee River Physicians, PLLC
1,484 mi
Emergency Medicine
16931 RANKIN AVE
Dunlap, TN 37327
  • Reassigned Medicare billing, Tennessee enrollment
  • 183 clinicians in this Medicare group
NPI 1699212761 (423) 949-2000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Emergency department visit with moderate level of medical decision making 99284
An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
131 services126 patients
Emergency department visit with high level of medical decision making 99285
An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.
115 services115 patients
Emergency department visit with low level of medical decision making 99283
An emergency department visit for a problem of moderate severity involves immediate medical attention for issues like minor fractures, burns, or high fever. The healthcare team will assess your condition, provide necessary treatment, and may suggest further tests or admission if required.
36 services31 patients
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only 93010
A routine electrocardiogram (ECG) with 12 leads is a simple, non-invasive test that records the electrical activity of your heart. It helps in identifying heart conditions by detecting irregularities in your heart rhythms. The results are interpreted and a report is provided.
34 services29 patients
Critical care, first 30-74 minutes 99291
Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.
24 services24 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Holy Cross Hospital - Salt Lake

Acute Care Hospitals · Salt Lake City, UT
2/5 CMS rating
OwnershipProprietary
CMS Certification Number460003
Location1050 East South TempleSalt Lake City, UT 84102 · Salt Lake County
Emergency services

University Of Utah Hospitals And Clinics

Acute Care Hospitals · Salt Lake City, UT
5/5 CMS rating
OwnershipGovernment - State
CMS Certification Number460009
Location50 North Medical DriveSalt Lake City, UT 84132 · Salt Lake County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84132 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
$84.41 typical visit price
range $54.34 – $166.03
Typical copayment $21.10 (range $13.58 – $41.50)
Most-billed visit code 99203
Established Patient
$96.35 typical visit price
range $17.23 – $135.20
Typical copayment $24.08 (range $4.30 – $33.80)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

92.06/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality85.57
Promoting Interoperability100
Improvement Activities40

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is David Crockett's NPI number?

The NPI number for David Crockett is 1104351592. It was assigned to this individual provider in the NPPES registry on April 24, 2017.

Where is David Crockett located?

David Crockett practices at University Of Utah School Of Medicine 30 N 1900 E 1c026, Salt Lake City, UT 84132. The listed phone number is (801) 581-2417.

What is David Crockett's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Is David Crockett enrolled in Medicare?

Yes. David Crockett is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for David Crockett's services?

According to the CMS Revalidation Reassignment List (October 2026 release), David Crockett reassigns Medicare benefits to 4 organizations: University Of Utah Adult Services (Salt Lake City, UT), Dhhs, Phs, Naihs, Shiprock Hospital (Teecnospos, AZ), Dhhs Ihs Phoenix Area (Polacca, AZ) and Tennessee River Physicians, PLLC (Dunlap, TN). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for David Crockett's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does David Crockett accept?

Health plans from Blue Cross Blue Shield of Wyoming list David Crockett as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is David Crockett affiliated with any hospitals?

According to CMS data, David Crockett is affiliated with Holy Cross Hospital - Salt Lake and University Of Utah Hospitals And Clinics.

When was this NPI record last updated?

The NPPES record for David Crockett was last updated on November 12, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.