Integrated Wellness Utah is a medicare enrolled "Pain Medicine - Interventional Pain Medicine" provider in South Jordan, Utah. Their current practice location is
10376 S Jordan Gtwy, South Jordan, Utah. You can reach out to their office (for appointments etc.) via phone at
(801) 816-0332.
Integrated Wellness Utah is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Integrated Wellness Utah
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1629400429.
Healthcare Provider's Profile
| Full Name | Integrated Wellness Utah |
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| Type | Facility |
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| Speciality | Pain Medicine - Interventional Pain Medicine |
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| Location | 10376 S Jordan Gtwy, South Jordan, Utah |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1629400429
- Provider Enumeration Date: 08/02/2013
- Last Update Date: 04/12/2022
Medicare PECOS Information:
- PECOS PAC ID: 7517194012
- Enrollment ID: O20131206001733
Medical Identifiers
Medical identifiers for Integrated Wellness Utah such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1629400429 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 111NI0900X | Chiropractor - Internist | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208VP0014X | Pain Medicine - Interventional Pain Medicine | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Integrated Wellness Utah acts as a billing entity for following providers:
| Provider Name | Kristina Michelle Reed |
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| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
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| Provider Identifiers | NPI Number: 1407057953
PECOS PAC ID: 8426158320
Enrollment ID: I20070706000297 |
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| Provider Name | Qamar R Khan |
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| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
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| Provider Identifiers | NPI Number: 1407026420
PECOS PAC ID: 4082750294
Enrollment ID: I20091001000216 |
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| Provider Name | Katie A Toledo |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1881884252
PECOS PAC ID: 7719072883
Enrollment ID: I20110609000159 |
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| Provider Name | Caleb J Lorenc |
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| Provider Type | Practitioner - Chiropractic |
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| Provider Identifiers | NPI Number: 1801140900
PECOS PAC ID: 6507004439
Enrollment ID: I20130604000535 |
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| Provider Name | Stephanie L Dupree |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1487931416
PECOS PAC ID: 0345409025
Enrollment ID: I20150924003347 |
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| Provider Name | Lauren Lightfield |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1104296623
PECOS PAC ID: 1355641002
Enrollment ID: I20151201003315 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Integrated Wellness Utah is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Integrated Wellness Utah
10376 S Jordan Gtwy,
South Jordan, UT 84095-3954
Ph: (801) 816-0332 | Integrated Wellness Utah
10376 S Jordan Gtwy,
South Jordan, UT 84095-3954
Ph: (801) 816-0332 |
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