Individual provider Active NPI

Xiomara N. Briseno, PA-C

  • Physician Assistant
  • Salt Lake City, UT
National Provider Identifier
1053963306
Registry record updated May 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12094622-1206 Issued in UT
Practice address
375 S Chipeta Way
Salt Lake City, UT 84108-1260
Phone
(801) 581-7766
NPI assigned
Jul 16, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 12094622-1206 UT Primary

Addresses

Primary practice location

375 S Chipeta Way
Salt Lake City, UT 84108-1260

Mailing address

375 S Chipeta Way
Salt Lake City, UT 84108-1260
Phone (801) 581-7766

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, AK2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240712003951 UT Practitioner - Physician Assistant 4385189406 Reassigns benefits to 1 organization
I20250317003551 AK Practitioner - Physician Assistant 4385189406 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15279MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services CurrentSince Jun 1, 2024 Accepting new patients
Norton Sound Health Corporation Physician Assistant CurrentSince Mar 5, 2025 Accepting new patients
University of Utah Adult Services CurrentSince Jun 1, 2024 Accepting new patients
Norton Sound Health Corporation CurrentSince Mar 5, 2025 Accepting new patients

Locations

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

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1563235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620691200000",
    "number": "1053963306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 S CHIPETA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081260",
            "telephone_number": "801-581-7766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 S CHIPETA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081260",
            "telephone_number": "801-581-7766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRISENO",
        "first_name": "XIOMARA",
        "middle_name": "N.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-16",
        "last_updated": "2021-05-11",
        "certification_date": "2021-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "12094622-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.