Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1285683029 Individual Practitioner Male Practitioner

Dr. Timothy Bock Icenogle , MD

Thoracic Surgery (Cardiothoracic Vascular Surgery) • Ogden, UT

Professional Overview & Biography Verified Profile Summary

Dr. Timothy Icenogle, MD is a registered healthcare professional specializing in Thoracic Surgery (Cardiothoracic Vascular Surgery) in Ogden, UT. Practice services are available at 4403 HARRISON BLVD STE 3835 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4403 Harrison Blvd Ste 3835

Ogden, UT 844033331

Telephone 8013873475
Fax 8013873480
Associated Practice Facility / Clinic
🏢 Ihc Health Services Inc Facility NPI 1962547695

Specialty Benchmarks & Practice Insights

Comparative analytics for Thoracic Surgery (Cardiothoracic Vascular Surgery) in Ogden, UT

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 29.0 Yrs
State Avg: 28.4 Yrs
Regional Practice Density
7 Specialists

Practicing in Ogden, UT (53 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2022-12-13
Thoracic Surgery (Cardiothoracic Vascular Surgery) Primary Specialty

NUCC Taxonomy Code: 208G00000X

State License UT 126770044-1205

A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.

Transplant Surgery

NUCC Taxonomy Code: 204F00000X

State License WA MD00026659

A surgeon who specializes in transplant surgery.

Thoracic Surgery (Cardiothoracic Vascular Surgery)

NUCC Taxonomy Code: 208G00000X

State License TX S9004

A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.

Thoracic Surgery (Cardiothoracic Vascular Surgery)

NUCC Taxonomy Code: 208G00000X

State License WA MD00026659

A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
1072495 (WA)
Medicaid State Provider ID
3756900 (ID)
Medicaid State Provider ID
3505645 (MT)

Secondary Practice Locations

3415 W Horizon Ave

Spokane, WA 992088493

Phone: 5092201900

100 Hillcrest Medical Blvd

Waco, TX 767128897

Phone: 2542022000

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

6 Associated Practitioners
Dr. David Goff , MD

Thoracic Surgery (Cardiothoracic Vascular Surgery)

NPI 1255449351

Doctor of Medicine (M.D.)

Dr. Michael Buch , MD

Internal Medicine - Cardiovascular Disease

NPI 1558479725

Doctor of Medicine (M.D.)

Dr. Albert Cain , MD

Thoracic Surgery (Cardiothoracic Vascular Surgery)

NPI 1609984863

Doctor of Medicine (M.D.)

Dr. Sherman Coleman , MD

Internal Medicine - Cardiovascular Disease

NPI 1699883843

Doctor of Medicine (M.D.)

Dr. Devin Rigg , MD

Thoracic Surgery (Cardiothoracic Vascular Surgery)

NPI 1891216602

Doctor of Medicine (M.D.)

Shelsea Oman , APRN

Nurse Practitioner - Family

NPI 1972987949

Advanced Practice Registered Nurse

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location December 13, 2022

Registered at 4403 HARRISON BLVD STE 3835, OGDEN, UT 844033331 (Tel: 8013873475)

📍
Updated Business Mailing Address December 13, 2022

Registered at PO BOX 27128, SALT LAKE CITY, UT 841270128

NPI Profile Active September 30, 2016

NPI status registered as active in NPPES database

📍
Updated Practice Location September 30, 2016

Registered at 3415 W HORIZON AVE, SPOKANE, WA 992088493 (Tel: 5092201900)

📍
Updated Business Mailing Address September 30, 2016

Registered at 3415 W HORIZON AVE, SPOKANE, WA 992088493 (Tel: 5092201900)

👤
Provider Name / Credentials Updated September 30, 2016

Recorded as TIMOTHY ICENOGLE, MD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 30, 2016

Transplant Surgery (License #MD00026659 in WA)

🟢
Initial NPI Registration & Enumeration May 09, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews
No patient reviews submitted yet for Dr. Timothy Icenogle. Be the first to share your experience!

Sign in to leave a review for Dr. Timothy Icenogle

Only verified registered users can submit ratings, post feedback, and upload facility photos.

NPI Administrative Meta

NPI Number: 1285683029
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 09, 2006
Last Update: December 13, 2022
Sole Proprietor: No

Mailing Address

Po Box 27128

Salt Lake City, UT 841270128

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.