Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

INNOVATION MEDICAL GROUP PC
Complete NPI Record 1235526682
Podiatrist in Salt Lake City, UT

Name: Complete NPI 1235526682 Record Table
Creator: NPI Profile
License: https://www.cms.gov/data-research/cms-data/data-available-everyone

Active since April 23, 2015CLIA 06D2235819 · Accreditation

6405 S 3000 E STE 300, SALT LAKE CITY, UT 84121(801) 266-3113(801) 266-5633 Get Directions

NPPES record last updated: July 26, 2026. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Jul 26, 2026, Feb 6, 2024, Oct 12, 2023 and 13 more (16 updates tracked since 2019).

Complete NPI Dataset

This page contains the complete raw NPPES record for Innovation Medical Group Pc (NPI 1235526682), a podiatrist organization in Salt Lake City, UT. All 74 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.

Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.

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Registry File Document Utilities

NPI: 1235526682: The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2: Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: Not available: The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business Name: INNOVATION MEDICAL GROUP PC: The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: Not available: Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 6: Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 6405 S 3000 E STE 300: The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City Name: SALT LAKE CITY: The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: UT: The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code: 841216977: The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Country Code If outside U S : US: The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
Provider Business Mailing Address Telephone Number: 8012663113: The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number: 8012665633: The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Provider First Line Business Practice Location Address: 6405 S 3000 E STE 300: The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: SALT LAKE CITY: The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: UT: The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 841216977: The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US: The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 8012663113: The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 8012665633: The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 4/23/2015: The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 7/26/2026: The date that a record was last updated or changed.
Authorized Official Last Name: WRIGHT: The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: TAYLOR: The first name of the authorized official.
Authorized Official Middle Name: G: The middle name of the authorized official.
Authorized Official Title or Position: CEO: The title or position of the authorized official.
Authorized Official Telephone Number: 8012663113: The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 163W00000X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 2: 163WI0500X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 2: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 3: 163WW0000X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 3: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 4: 207Q00000X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 4: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 5: 207ZP0102X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 5: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 6: 208600000X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 6: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 7: 213E00000X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 7: Y: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 8: 213ES0103X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 8: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 9: 225X00000X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 9: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 10: 2471V0106X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 10: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 11: 332B00000X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 11: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 12: 363A00000X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 12: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 13: 363LC1500X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 13: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 14: 363LF0000X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 14: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 15: 363LP0808X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 15: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Is Organization Subpart: N: Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Authorized Official Credential Text: DPM: The professional credential(s) of the authorized official listed on the provider's NPI record. Examples include MD (Doctor of Medicine), DO (Doctor of Osteopathy), RN (Registered Nurse), DDS (Doctor of Dental Surgery), PhD, or other recognized designations that reflect the official's qualifications.
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 5: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 6: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 7: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 8: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 9: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 10: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 12: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 13: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 14: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 15: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
NPI Certification Date: 7/26/2026: The date on which the National Provider Identifier (NPI) was officially assigned and certified to the provider. This reflects when the provider's NPI record first became active in the NPPES system.

Other Organization Names 1

Additional business and trade names this provider has on file with the NPPES registry.

Innovation Medical Group Doing Business As

1/1

Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.

Secondary Practice Locations 18

The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.

3360 S 15th E

1/18

Idaho Falls, ID 83404-8321 · Phone (208) 932-7024

6405 S 3000 E Ste 201

2/18

Salt Lake City, UT 84121-6990 · Phone (801) 266-3113

27B Talisman Dr Unit 2

3/18

Pagosa Springs, CO 81147-7914 · Phone (970) 903-9853 · Fax (970) 616-6745

2095 N Dolores Rd

4/18

Cortez, CO 81321-8924 · Phone (970) 564-8086 · Fax (970) 564-8087

1125 S Camino Del Rio Ste 300B

5/18

Durango, CO 81303-6886 · Phone (970) 659-9850 · Fax (970) 579-6750

745 S Progress Ave Ste 150

6/18

Meridian, ID 83642-5610 · Phone (208) 813-1958 · Fax (208) 600-6905

406 S Park Ave

7/18

Aztec, NM 87410 · Phone (505) 334-2852

1315 Snowden St

8/18

Silverton, CO 81433-5108 · Phone (970) 903-9853 · Fax (970) 616-6745

4760 N Butler Ave Ste B2

9/18

Farmington, NM 87401-0816 · Phone (505) 324-6300 · Fax (505) 327-2218

3152 N University Ave, Suite 240

10/18

Provo, UT 84604 · Phone (801) 900-5655

1900 E Historic Highway 66 Ste 1

11/18

Gallup, NM 87301-4883 · Phone (505) 324-6300 · Fax (505) 327-2218

16 E 300 S

12/18

Monticello, UT 84535 · Phone (435) 270-0271 · Fax (435) 270-0273

965 E 700 S Ste 105

13/18

St George, UT 84790-4084 · Phone (435) 775-2324 · Fax (435) 775-2041

836 S Angel St Ste 102

14/18

Layton, UT 84041-3687 · Phone (435) 291-1375 · Fax (801) 823-6595

4740 N Butler Ave

15/18

Farmington, NM 87401-0826 · Phone (505) 324-6300 · Fax (505) 327-2218

3360 Washington Pkwy

16/18

Idaho Falls, ID 83404-8332 · Phone (208) 932-7024 · Fax (208) 904-4447

270 E 8th Ave Ste N102

17/18

Durango, CO 81301-5708 · Phone (801) 266-3113 · Fax (801) 266-5633

46 N Main St

18/18

Blanding, UT 84511-2830 · Phone (435) 270-0271 · Fax (435) 270-0272

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