Kyle Allan Vance

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11353630-1206 Issued in UT

Practice address

10433 S Redwood Rd Ste B
South Jordan, UT 84095-8502

Phone

(801) 260-1919

NPI assigned

Jul 22, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• After Hours Medical LLC

  • Urgent Care Clinic/Center
  • Draper, UT
  • NPI 1437251279

  UT

  Medicare reassignment
• After Hours Medical LLC, Dba Medallus Medical

  • Urgent Care Clinic/Center
  • Draper, UT
  • NPI 1992078349
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563753600000",
    "number": "1003469867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95590",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840950590",
            "telephone_number": "801-352-9500",
            "fax_number": "801-352-7976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10433 S REDWOOD RD STE B",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840958502",
            "telephone_number": "801-260-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANCE",
        "first_name": "KYLE",
        "middle_name": "ALLAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-22",
        "last_updated": "2019-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "11353630-1206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "11353630-1206",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "afterhoursmedical.com",
            "affiliation": "N",
            "address_1": "10433 S Redwood Rd Ste B",
            "city": "South Jordan",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840958502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Edward Douglas Vaka'Uta, LCSW
• Echo Valbuena, LCSW
• Valere Behavioral Health LLC
• Jenna Rose Van Hemert, PT, DPT, NCS
• Eve Van Wagoner, PHARMD
• McKenzi Vance, PT
• Vicki Vandenberghe, CSW
• Paige Vandersloot, LMFT
• Mitchel Jay Vanwagoner, LCSW
• Vanzo-Koch Enterprises, LLC

• All providers in South Jordan, UT
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.