BROCK BODILY
NPI 1366004517
Physician Assistant - Surgical in South Jordan, UT
NPI Status: Active since July 08, 2019
Contact Information
10623 S REDWOOD RD # 101
SOUTH JORDAN, UT
ZIP 84095
Phone: (801) 566-4242
- Individual
- Male
- Physician Assistant
- Surgical
- PECOS Enrolled
About BROCK BODILY
This page provides the complete NPI Profile along with additional information for Brock Bodily, a provider established in South Jordan, Utah with a medical specialization in Physician Assistant, focusing in surgical . The healthcare provider is registered in the NPI registry with number 1366004517 assigned on July 2019. The practitioner's primary taxonomy code is 363AS0400X with license number 11353289-8002 (UT). The provider is registered as an individual and his NPI record was last updated 6 years ago.
- NPI
- 1366004517
- Provider Name
- BROCK BODILY
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 10623 S REDWOOD RD # 101 SOUTH JORDAN, UT 84095
- Location Phone
- (801) 566-4242
- Mailing Address
- 1265 N 850 E PLEASANT GROVE, UT 84062
- Is Sole Proprietor?
- No
- Enumeration Date
- 07-08-2019
- Last Update Date
- 07-08-2019
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Physician Assistant Surgical
- Taxonomy Code
- 363AS0400X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- 11353289-8002
- License State
- UT
Medicare Participation & PECOS Enrollment Status
Brock Bodily is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Durable Medical Equipment (DME) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: No
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): No
Eligible to Order or Refer Power Mobility Devices: Yes
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 3 | 6 | 6 | 0 | 0 | 4 | 5 | 1 | 7 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 3 | 12 | 6 | 0 | 0 | 8 | 5 | 2 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 3 + 1 + 2 + 6 + 0 + 0 + 8 + 5 + 2 + 24 = 53 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 53 = 7 | 7 | ||||||||
The NPI number 1366004517 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1366004517, enumerated in the NPI registry as an "individual" on July 08, 2019
The provider is located at 10623 S Redwood Rd # 101 South Jordan, Ut 84095 and the phone number is (801) 566-4242
The provider's speciality is Physician Assistant with taxonomy code 363AS0400X with a focus in Surgical
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Durable Medical Equipment (DME) and Power Mobility Devices.
This NPI record was last updated on July 08, 2019. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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