ELLSWORTH FOOT AND ANKLE CLINIC
Complete NPI Record 1942549795
Podiatrist - Foot & Ankle Surgery in Riverton, UT
Active since February 13, 2013
Complete NPI Dataset
This page contains the complete raw NPPES record for Ellsworth Foot And Ankle Clinic (NPI 1942549795), a podiatrist organization in Riverton, UT. All 32 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, 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.
Registry File Document Utilities
- NPI: 1942549795 Field 1/32
- 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 Field 2/32
- 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 Field 3/32
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: ELLSWORTH FOOT AND ANKLE CLINIC Field 4/32
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider First Line Business Mailing Address: 12523 S CREEK MEADOW RD STE 105 Field 5/32
- 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: RIVERTON Field 6/32
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: UT Field 7/32
- 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: 840657299 Field 8/32
- 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 Field 9/32
- 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: 8012536886 Field 10/32
- 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: 8012536888 Field 11/32
- 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: 12523 S CREEK MEADOW RD STE 105 Field 12/32
- 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: RIVERTON Field 13/32
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: UT Field 14/32
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 84065 Field 15/32
- 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 Field 16/32
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 8012536886 Field 17/32
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 8012536888 Field 18/32
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: ELLSWORTH Field 21/32
- 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: RYAN Field 22/32
- The first name of the authorized official.
- Authorized Official Title or Position: OWNER, MANAGER Field 23/32
- The title or position of the authorized official.
- Authorized Official Telephone Number: 8015500955 Field 24/32
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 213ES0103X Field 25/32
- 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.
- Provider License Number 1: 8400193-0501 Field 26/32
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 1: UT Field 27/32
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 28/32
- 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 Field 29/32
- 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 Field 30/32
- 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: 193400000X SINGLE SPECIALTY GROUP Field 31/32
- 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.
Secondary Practice Locations 5
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.
2019 E Riverside Dr Ste A101
Location 1/5St George, UT 84790-8147 · Phone (801) 253-6886 · Fax (801) 253-6888
357 N Main Street
Location 2/5Huntington, UT 84528 · Phone (801) 253-6886 · Fax (801) 253-6888
777 N 500 W Ste 103
Location 3/5Provo, UT 84601-1552 · Phone (801) 253-6886 · Fax (801) 253-6888
3130 S Highland Dr # B4
Location 4/5Salt Lake City, UT 84106-3095 · Phone (801) 253-6886 · Fax (801) 253-6888
4019 W 12600 S, Suite 120
Location 5/5Riverton, UT 84096-7401 · Phone (801) 253-6886 · Fax (801) 253-6888
No registry entries match your active lookup criteria.
