Carly Rae Davis, MD in Riverton, UT

Carly Rae Davis, MD is a medicare enrolled "Pediatrics" physician in Riverton, Utah. Her current practice location is 12391 S 4000 W, Riverton, Utah. You can reach out to her office (for appointments etc.) via phone at (801) 302-1700.

Carly Rae Davis is licensed to practice in Utah (license number 7996415-1205) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1801121108.

Contact Information

	Carly Rae Davis, MD
	12391 S 4000 W, Riverton, UT 84096-7012
	(801) 302-1700
	Not Available

Map and Direction

Physician's Profile

Full Name	Carly Rae Davis
Gender	Female
Speciality	Pediatrics
Location	12391 S 4000 W, Riverton, Utah
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1801121108
Provider Enumeration Date: 10/05/2009
Last Update Date: 02/20/2025

Medicare PECOS Information:

PECOS PAC ID: 8921231028
Enrollment ID: I20250321000724

Medical Identifiers

Medical identifiers for Carly Rae Davis such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1801121108	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
208000000X	Pediatrics	R70650 (Arizona)	Secondary
2080P0208X	Pediatrics - Pediatric Infectious Diseases	7996415-1205 (Utah)	Secondary
208000000X	Pediatrics	7996415-1205 (Utah)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Carly Rae Davis allows following entities to bill medicare on her behalf.

Entity Name	Granger Medical Clinic Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1184657041 PECOS PAC ID: 3476465691 Enrollment ID: O20031105000159

Entity Name	Granger Medical Specialists Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1376159368 PECOS PAC ID: 4587074356 Enrollment ID: O20201105002207

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. Carly Rae Davis 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
Carly Rae Davis, MD 12391 S 4000 W, Riverton, UT 84096-7012 Ph: (801) 302-1700	Carly Rae Davis, MD 12391 S 4000 W, Riverton, UT 84096-7012 Ph: (801) 302-1700

Reviews and Comments

Pediatrics Doctors in Riverton, UT

Dr. Monica Child Wonnacott, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 12391 S 4000 W, Riverton, UT 84096 Phone: 801-302-1700 Fax: 801-302-1714
Ms. Katherine Douglas Westmoreland, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 3723 W 12600 S, Ste 450, Riverton, UT 84065 Phone: 801-285-4543 Fax: 801-285-4540
Kristina D Esham, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 3723 W 12600 S, Suite 450, Riverton, UT 84065 Phone: 801-285-4543
Dr. Stasha S Lewis, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 3723 W 12600 S Ste 150, Riverton, UT 84065 Phone: 801-285-4561
Dr. Shellie J Ring, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 3723 W 12600 S Ste 330, Riverton, UT 84065 Phone: 801-285-4543
J Timothy Duffy, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 3723 W 12600 S, Suite 450, Riverton, UT 84065 Phone: 801-285-4543
Dr. Craig Alan Coleby, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 12391 S 4000 W, Suite 100, Riverton, UT 84096 Phone: 801-302-1700

Carly Rae Davis, MD - Medicare Pediatrics in Riverton, UT