Individual provider Active NPI

John Evan Thomas, PA-C

  • Surgical Physician Assistant
  • Salt Lake City, UT
National Provider Identifier
1053838532
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
10403324-1206 Issued in UT
Practice address
30 N 1900 E RM 3B420
Salt Lake City, UT 84132-0002
Phone
(801) 213-2700
Fax
(801) 585-2891
NPI assigned
Aug 25, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 10403324-8906 UT
Physician Assistant 363A00000X 10403324-1206 UT
Surgical Physician Assistant 363AS0400X 10403324-1206 UT Primary

Addresses

Primary practice location

30 N 1900 E RM 3B420
Salt Lake City, UT 84132-0002

Mailing address

848 E 750 N
Bountiful, UT 84010-2853
Phone (801) 821-3649

Other practice location 1

165 N University Ave
Farmington, UT 84025-2990
Phone (801) 213-3200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ethomas256725@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20171025001204 UT Practitioner - Physician Assistant 3375819089 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

165 N University Ave
Farmington, UT 84025-2990
Phone (801) 581-6709

50 N Medical Dr
Salt Lake City, UT 84132-0001
Phone (801) 581-2121

50 N Medical Dr
Salt Lake City, UT 84132-0100
Phone (801) 213-2995

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.77 of 100Reported as group
Quality
91.47
Promoting interoperability
100
Improvement activities
40
Cost
74.42

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10403324-8906UTMDUrology Physician
10403324-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services CurrentSince Oct 1, 2017 Accepting new patients
University of Utah Adult Services CurrentSince Oct 1, 2017 Accepting new patients
Bronson Lakeview Hospital Past Accepting new patients

Locations

165 N University Ave
Farmington, UT 84025
Phone (801) 213-3200

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Interoperability endpoints

  • Direct secure messaging: ethomas256725@direct.med.utah.edu

Organizations & group practices 4

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1503619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1053838532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "848 E 750 N",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840102853",
            "telephone_number": "801-821-3649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N 1900 E RM 3B420",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320002",
            "telephone_number": "801-213-2700",
            "fax_number": "801-585-2891"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "165 N University Ave",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "UT",
            "postal_code": "840252990",
            "country_code": "US",
            "telephone_number": "801-213-3200",
            "fax_number": "801-213-6788",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "JOHN",
        "middle_name": "EVAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-25",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "UT",
            "license": "10403324-8906",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "10403324-1206",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "UT",
            "license": "10403324-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ethomas256725@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.