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NORTHEASTERN UTAH MEDICAL GROUP
NPI 1316316482
Physician Assistant in Roosevelt, UT

Active since September 18, 2015
250 W 300 N, ROOSEVELT, UT 84066(435) 722-4691(435) 722-9291 Get Directions Write a Review

NPPES record last updated: September 18, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Northeastern Utah Medical Group NPPES

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

NORTHEASTERN UTAH MEDICAL GROUP (NPI 1316316482) is a healthcare organization registered as a physician assistant in Roosevelt, Utah and active in the NPI registry since September 2015. The organization lists James I Marshal, Ceo, as its authorized official.

NPPES Registry Identity

NPI1316316482
Entity TypeOrganization
Primary Taxonomy363A00000X
Legal Business NameNORTHEASTERN UTAH MEDICAL GROUP
Location Address250 W 300 NRoosevelt, UT 84066-2336
Mailing Address250 W 300 NRoosevelt, UT 84066-2336 · (435) 722-4691 · Fax (435) 722-9291
Phone(435) 722-4691
Fax(435) 722-9291
Organization SubpartYesParent: Uintah Basin Medical Center
Authorized OfficialJames I MarshalCeo · (435) 722-6162
Enumeration DateSeptember 18, 2015
✔ NPI 1316316482 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in UT · 6411766-1206
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
250 W 300 N, Roosevelt, UT 84066
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 46D0726399

Northeastern Utah Medical Group · Roosevelt, UT
Expired · Jul 31, 2026
CLIA Number46D0726399
Laboratory TypePhysician Office
Certificate Effective DateMarch 28, 2024
Certificate Expiration DateJuly 31, 2026
Laboratory DirectorJohn Blake
Laboratory Phone(435) 722-4691
Laboratory LocationNortheastern Utah Medical Group210 W 300 N, Roosevelt, UT 84066
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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.

MRS. VALARIE JEAN HAMBLIN RN, BSN, LCCE
Registered Nurse
250 W 300 N
ROOSEVELT, UT 84066
Duchesne County (435) 722-6150
SHAWN W HAWKINS
Physical Therapist
250 W 300 N
ROOSEVELT, UT 84066
Duchesne County (435) 722-6163
UBMC ANESTHESIOLOGY
Nurse Anesthetist, Certified Registered
250 W 300 N
ROOSEVELT, UT 84066
Duchesne County (801) 432-2600
KERRY ROBERT BAUM JR. MD
Surgery
250 W 300 N, UINTAH BASIN MEDICAL CENTER
ROOSEVELT, UT 84066
Duchesne County (435) 722-4691
ROYCE PORTER
Occupational Therapist
250 W 300 N
ROOSEVELT, UT 84066
Duchesne County (435) 725-7448
MR. WESTON ROSS WEAVER RPH
Pharmacist
250 W 300 N
ROOSEVELT, UT 84066
Duchesne County (435) 722-6123
DR. CHRISTIAN BOEKWEG DO
Family Medicine
250 W 300 N
ROOSEVELT, UT 84066
Duchesne County (435) 722-4691
GREG NEILSEN OTR/L
Occupational Therapist
250 W 300 N
ROOSEVELT, UT 84066
Duchesne County (435) 722-6186

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 Northeastern Utah Medical Group's NPI number?

The NPI number for Northeastern Utah Medical Group is 1316316482. It was assigned to this organization in the NPPES registry on September 18, 2015.

Where is Northeastern Utah Medical Group located?

Northeastern Utah Medical Group is located at 250 W 300 N, Roosevelt, UT 84066. The listed phone number is (435) 722-4691.

What is Northeastern Utah Medical Group's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

What insurance does Northeastern Utah Medical Group accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Northeastern Utah Medical Group 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.

When was this NPI record last updated?

The NPPES record for Northeastern Utah Medical Group was last updated on September 18, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.