Doctor profile · Federal record
Dr. KELLY DAHLSTROM, D.O.
Neuroradiology Physician (CMS: DIAGNOSTIC RADIOLOGY) · Diagnostic Radiology Physician · SALT LAKE CITY, UT
- NPI 1134533417
- Accepts Medicare
- MIPS 87.6 / 100 · 2023
- 12 yrs in practice
- Female
- Solo practice
- No sanctions
Practice & contact
Operates at 2 locations .
- Primary practice
-
30 N 1900 E RM 1A071
SALT LAKE CITY, UT 841322140
(801) 581-7553 - Additional location
-
1500 S Main St
Fort Worth, TX 761044917
(817) 702-1255
Credentials & registration
- NPI registered
- June 2014 — 12 yrs on file
- Profile last updated
- May 5, 2020
- Year of graduation
- 2014 — 12 yrs since
- Specialty taxonomy
- 2085N0700X — NUCC code
- State license (1)
- Utah #11262272-1204
Federal sanctions & exclusions
No sanctions, exclusions or revocations on file
Checked against OIG LEIE on NPI 1134533417. Last verified May 11, 2026.Medicare procedures · 2023
Top services delivered
Total services
1,846
Distinct HCPCS
10
Medicare allowed
$109,053
| HCPCS | Description | Services | Patients | Avg allowed | |
|---|---|---|---|---|---|
70450 |
Ct scan head or brain without contrast | 418 | 374 | $38 | |
70553 |
Mri scan of brain before and after contrast | 276 | 255 | $105 | |
72125 |
Ct scan of upper spine without contrast | 94 | 94 | $44 | |
70553 |
Mri scan of brain before and after contrast | 87 | 84 | $103 | |
70491 |
Ct scan of soft tissue of neck with contrast | 83 | 80 | $63 | |
70551 |
Mri scan of brain without contrast | 71 | 71 | $68 | |
72082 |
X-ray of entire middle and lower spine, 2-3 views | 71 | 70 | $14 | |
70496 |
Ct scan of blood vessels of head with contrast | 60 | 60 | $78 | |
70498 |
Ct scan of blood vessels of neck with contrast | 60 | 60 | $76 | |
70355 |
X-ray of lower jaws, upper jaws and teeth | 54 | 54 | $9 |
In context: peer comparison
Among 9 peers in this city , average services per provider: 64. This provider delivers 29× the peer median.