Individual provider Active NPI

Robert Wright, PA-C

  • Physician Assistant
  • Salem, UT
National Provider Identifier
1073284345
Registry record updated Dec 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12480125-1206 Issued in UT
Practice address
555 W Sr 164
Salem, UT 84653-8465
Phone
(801) 465-4896
NPI assigned
Sep 25, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 12480125-1206 UT Primary
Medical Physician Assistant 363AM0700X 12480125-1206 UT

Addresses

Primary practice location

555 W Sr 164
Salem, UT 84653-8465

Mailing address

1055 N 500 W
Attn Credentialing
Provo, UT 84604
Phone (801) 354-8225

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address medreview@reverehealth.com Central Utah Clinic, P.C.

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
I20220318001790 UT Practitioner - Physician Assistant 6204221765 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Utah Carenow Urgent Care LLCGroup PAC ID 7113326208, 31 clinicians

Practice addresses (Care Compare)

117 N State St
Orem, UT 84057-5509
Phone (801) 607-3130

441 S Redwood Rd
Salt Lake City, UT 84104-3539
Phone (801) 973-2588

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12480125-1206UTMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Revere Health PC CurrentSince Feb 28, 2022 Accepting new patients
Revere Health PC CurrentSince Feb 28, 2022 Accepting new patients
Utah Imaging Associates Inc Past Accepting new patients

Locations

1055 N 500 W
Ste 212
Provo, UT 84604
Phone (801) 374-2362

1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000

555 W State Road 164
Salem, UT 84653
Phone (801) 465-4896

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.

NPI Registry JSON

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

{
    "created_epoch": "1632528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672272000000",
    "number": "1073284345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "ATTN CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "84604",
            "telephone_number": "801-354-8225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 W SR 164",
            "city": "SALEM",
            "state": "UT",
            "postal_code": "846538465",
            "telephone_number": "801-465-4896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRIGHT",
        "first_name": "ROBERT",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-25",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "12480125-1206",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "12480125-1206",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Central Utah Clinic, P.C.",
            "address_1": "555 W SR 164",
            "city": "Salem",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846538465",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salem, UT

Sources for this page

Verify at the official NPI Registry.