| Northeastern Utah Medical Group | |
|
210 W 300 N 7-3 Roosevelt UT 84066 | |
| (435) 722-3971 | |
| (435) 722-6104 |
| Full Name | Northeastern Utah Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 210 W 300 N 7-3, Roosevelt, Utah |
| Authorized Official Name and Position | Brent H Hales (CFO) |
| Authorized Official Contact | 4357226164 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeastern Utah Medical Group 210 W 300 N Roosevelt UT 84066-2336 Ph: (435) 722-3971 | Northeastern Utah Medical Group 210 W 300 N 7-3 Roosevelt UT 84066 Ph: (435) 722-3971 |
| NPI Number | 1982664199 |
|---|---|
| Provider Enumeration Date | 03/23/2006 |
| Last Update Date | 10/23/2025 |
| Medicare PECOS PAC ID | 2961496609 |
|---|---|
| Medicare Enrollment ID | O20040414000471 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982664199 | NPI | - | NPPES |
| 840276435084 | Medicaid | UT |
| Provider Name | Penny J Peacock |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902864762 PECOS PAC ID: 0446163877 Enrollment ID: I20031111000328 |
| Provider Name | Gary F Graham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811910359 PECOS PAC ID: 7719870492 Enrollment ID: I20040205001007 |
| Provider Name | Bradley Jenkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912968538 PECOS PAC ID: 3971494535 Enrollment ID: I20040323000715 |
| Provider Name | Michael T Olsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356437891 PECOS PAC ID: 0143203380 Enrollment ID: I20040609001205 |
| Provider Name | John Nolte |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1194786095 PECOS PAC ID: 8628016300 Enrollment ID: I20050422000324 |
| Provider Name | Gordon Scott Olsen |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1235237744 PECOS PAC ID: 0547220915 Enrollment ID: I20050601000882 |
| Provider Name | Lynn Morrill |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1497715593 PECOS PAC ID: 9335162536 Enrollment ID: I20060112000926 |
| Provider Name | Gregory L Staker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275593717 PECOS PAC ID: 1759305980 Enrollment ID: I20060114000030 |
| Provider Name | Ben D Williams |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1437202280 PECOS PAC ID: 9133161193 Enrollment ID: I20080528000450 |
| Provider Name | Brian K Gardner |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1396943825 PECOS PAC ID: 6406921717 Enrollment ID: I20080821000289 |
| Provider Name | Derrick Haslem |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1730389701 PECOS PAC ID: 1658424049 Enrollment ID: I20090803000305 |
| Provider Name | Amy Olsen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598991275 PECOS PAC ID: 6103951363 Enrollment ID: I20100315000095 |
| Provider Name | James D White |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1316908122 PECOS PAC ID: 5991833303 Enrollment ID: I20100505000777 |
| Provider Name | Shane K Powell |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1750342655 PECOS PAC ID: 9234267642 Enrollment ID: I20100505000810 |
| Provider Name | Jason Scott Beales |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891755872 PECOS PAC ID: 2769510171 Enrollment ID: I20100505000841 |
| Provider Name | John Steele Blake |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1508826587 PECOS PAC ID: 3173651395 Enrollment ID: I20100510000420 |
| Provider Name | Rodney Stan Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952495582 PECOS PAC ID: 6800879032 Enrollment ID: I20100618000195 |
| Provider Name | Kirk J Woodward |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811083348 PECOS PAC ID: 8820071053 Enrollment ID: I20100618000215 |
| Provider Name | Karl Lee Breitenbach |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457447906 PECOS PAC ID: 8224168224 Enrollment ID: I20100618000261 |
| Provider Name | Michael Ernest Vanbibber |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1598851503 PECOS PAC ID: 7517090608 Enrollment ID: I20100726000598 |
| Provider Name | Jeffrey L Wheeler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699942987 PECOS PAC ID: 1759425432 Enrollment ID: I20110729000517 |
| Provider Name | John S Wells |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831359744 PECOS PAC ID: 0042354730 Enrollment ID: I20110802000531 |
| Provider Name | David Mathis Thayn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386802916 PECOS PAC ID: 2961652789 Enrollment ID: I20121101000027 |
| Provider Name | Kristopher S Riser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972855088 PECOS PAC ID: 6002061488 Enrollment ID: I20130311000285 |
| Provider Name | Sarah Jane Woody |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265720205 PECOS PAC ID: 0345417366 Enrollment ID: I20130529000304 |
| Provider Name | Bruce F Arnold |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1164400438 PECOS PAC ID: 7012100415 Enrollment ID: I20130803000164 |
| Provider Name | Alec Higgins Rimmasch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013346634 PECOS PAC ID: 3577791011 Enrollment ID: I20140108001489 |
| Provider Name | Zachary Reese |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1871735340 PECOS PAC ID: 4082846084 Enrollment ID: I20150505001211 |
| Provider Name | Ryan Wilcox |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1033344767 PECOS PAC ID: 8820254139 Enrollment ID: I20150611000068 |
| Provider Name | Terence Rhodes |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1124236310 PECOS PAC ID: 5890951107 Enrollment ID: I20160429001807 |
| Provider Name | Kerry R Baum |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1093004202 PECOS PAC ID: 4284866344 Enrollment ID: I20160729000818 |
| Provider Name | Ramya Thota |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1154551273 PECOS PAC ID: 4880850130 Enrollment ID: I20160802000218 |
| Provider Name | Audrie C Wisell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518417054 PECOS PAC ID: 0446539233 Enrollment ID: I20161118001024 |
| Provider Name | Mark Andrew Lewis |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1801051578 PECOS PAC ID: 2769550441 Enrollment ID: I20161123001934 |
| Provider Name | Sandra D Rust |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992251268 PECOS PAC ID: 4385925445 Enrollment ID: I20170103001568 |
| Provider Name | Margaret Elizabeth Mccormick Van Meter |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1528231511 PECOS PAC ID: 9931252202 Enrollment ID: I20170712002140 |
| Provider Name | Richard Johnson |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1124253166 PECOS PAC ID: 9830407659 Enrollment ID: I20180302000402 |
| Provider Name | Jacqueline Marie Humpherys |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1447400437 PECOS PAC ID: 1951649540 Enrollment ID: I20190206000760 |
| Provider Name | Phillip Blaine Whiting |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1326337296 PECOS PAC ID: 2860702388 Enrollment ID: I20190731001106 |
| Provider Name | Matthew D Mckee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891149621 PECOS PAC ID: 1850628983 Enrollment ID: I20190812002109 |
| Provider Name | Tanya Sarah Boren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154974657 PECOS PAC ID: 2365772191 Enrollment ID: I20190922000039 |
| Provider Name | Shakaib S Qureshi |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1821063108 PECOS PAC ID: 7517924137 Enrollment ID: I20200413000904 |
| Provider Name | Shalese Marie Killian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346875325 PECOS PAC ID: 4880025527 Enrollment ID: I20200512002781 |
| Provider Name | Jacob Aaron Barlow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669002150 PECOS PAC ID: 9032532924 Enrollment ID: I20200710001468 |
| Provider Name | Mark E Henderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760902498 PECOS PAC ID: 3072888239 Enrollment ID: I20200825000485 |
| Provider Name | Nikil V Moodabagil |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1477971232 PECOS PAC ID: 7911293931 Enrollment ID: I20210611001522 |
| Provider Name | Kyler Black |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518499268 PECOS PAC ID: 1658775622 Enrollment ID: I20210812002817 |
| Provider Name | Samuel Mark Bertoch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417525544 PECOS PAC ID: 7810392271 Enrollment ID: I20210823002405 |
| Provider Name | Samuel M. Wilson |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1477865194 PECOS PAC ID: 4880841956 Enrollment ID: I20210826001828 |
| Provider Name | Nathan Robert Peterson |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1194135350 PECOS PAC ID: 8224321518 Enrollment ID: I20211022002472 |
| Provider Name | Angala Dee Bryson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831773449 PECOS PAC ID: 8325433741 Enrollment ID: I20220322002658 |
| Provider Name | Chelsea Ann Hoopes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730763335 PECOS PAC ID: 9739561341 Enrollment ID: I20220728003359 |
| Provider Name | John David Marett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821559519 PECOS PAC ID: 0446632830 Enrollment ID: I20220802000725 |
| Provider Name | Megan Hopkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255067757 PECOS PAC ID: 4486030889 Enrollment ID: I20221010000744 |
| Provider Name | James L Potter |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1477942159 PECOS PAC ID: 4385955178 Enrollment ID: I20230104001241 |
| Provider Name | David Wendell Ririe |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1952307605 PECOS PAC ID: 9931160157 Enrollment ID: I20230224000464 |
| Provider Name | Erik J Rupard |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1437211299 PECOS PAC ID: 5496937484 Enrollment ID: I20230516003357 |
| Provider Name | Robert Nielson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194413633 PECOS PAC ID: 0345608402 Enrollment ID: I20230621002891 |
| Provider Name | Daniel Sims |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1669836532 PECOS PAC ID: 3476886409 Enrollment ID: I20230914004056 |
| Provider Name | Annemarie Rousseau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477075315 PECOS PAC ID: 6608220355 Enrollment ID: I20230928001846 |
| Provider Name | Michaela J Curry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639796246 PECOS PAC ID: 8022460971 Enrollment ID: I20240117000767 |
| Provider Name | Tak-ming Ko |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1003995713 PECOS PAC ID: 5496780413 Enrollment ID: I20240411001259 |
| Provider Name | Christian Boekweg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144806894 PECOS PAC ID: 3375947948 Enrollment ID: I20240717003522 |
| Provider Name | Dallas Smuin |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1659862555 PECOS PAC ID: 0345609764 Enrollment ID: I20240718004649 |
| Provider Name | Benjamin Zenger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861073728 PECOS PAC ID: 7618372905 Enrollment ID: I20240805002489 |
| Provider Name | Robert Rice |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1699720136 PECOS PAC ID: 7810900305 Enrollment ID: I20241028001328 |
| Provider Name | Steve Pehrson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164531968 PECOS PAC ID: 2264454974 Enrollment ID: I20241122001451 |
| Provider Name | Khurram Tariq |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1144586181 PECOS PAC ID: 7810298056 Enrollment ID: I20241125001859 |
Ashley Valley Physician Practice, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 409 S 200 E, Roosevelt, UT 84066 Phone: 435-725-3327 Fax: 435-725-3331 | |
Uintah Basin Medical Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 250 W 300 N, Roosevelt, UT 84066 Phone: 435-725-7448 Fax: 435-722-9291 | |
Ashley Valley Physician Practice Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 409 S 200 E, Roosevelt, UT 84066 Phone: 435-781-0757 Fax: 435-781-2628 |