Organization
Custom Medical Services
Provider's NPPES record last updated: September 11, 2025
Overview
- Entity Type
- Organization
- NPI
- 1669452298
- Primary Specialty
- Family Medicine — Adolescent Medicine
- Practice Location
- Roosevelt, Utah
- Organization Subpart
- No
Federal Screening
NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.
List of Excluded Individuals/Entities (LEIE)
HHS Office of Inspector General
No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.
- Source data
- September 10, 2026
- Records indexed
- 84,001
- Screened
- Sep 17, 2026, 11:39 PM UTC
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
SAM.gov Exclusions
U.S. General Services Administration
SAM.gov Exclusions was not checked.
SAM.gov screening is not configured on this deployment. No SAM check has been performed.
- Screened
- Not checked
This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
Searches OIG LEIE and SAM.gov by name and reviews every potential match.
Specialties & Taxonomies
- Primary
Family Medicine
Adolescent Medicine
Allopathic & Osteopathic Physicians
A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs.
Taxonomy code 207QA0000X Legal Medicine
Other Service Providers
The specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical examinations at crime scenes, performance of autopsies, giving of expert medical testimony in judicial proceedings, medical treatment of inmates of penal institutions, the practice of trauma medicine in law enforcement settings, and other clinical practice and medical science applications in the fields of law, law enforcement, and corrections.
Taxonomy code 173000000XFamily Medicine
Adult Medicine
Allopathic & Osteopathic Physicians
The NUCC recommends this code not be used. Choose a more appropriate code.
Taxonomy code 207QA0505XFamily Medicine
Geriatric Medicine
Allopathic & Osteopathic Physicians
A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital.
Taxonomy code 207QG0300X
Provider-Reported License Information
- Legal Medicine (Utah)
- V09531
- Family Medicine (Utah)
- V09531
Practice Locations
Practice Location
Rr 3 Box 3053
Roosevelt, Utah 84066-9609
Phone: (435) 722-7704
Record Information
- Enumeration Date
- January 19, 2006
- Provider's NPPES Record Last Updated
- September 11, 2025
- NPISignal NPPES Dataset
- August 2026
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