Active NPI
Stephen G Roper, PA
- Physician Assistant
- Salt Lake City, UT
National Provider Identifier
1124061155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 51877361206
- Practice address
- 1160 E 3900 S
#5000
Salt Lake City, UT 84124-1275 - Phone
- (801) 262-8486
- Fax
- (801) 262-9752
- NPI assigned
- Jun 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 51877361206 | UT | Primary |
Addresses
Primary practice location
1160 E 3900 S
#5000
Salt Lake City, UT 84124-1275
Mailing address
1160 E 3900 S
#5000
Salt Lake City, UT 84124-1275
Phone (801) 262-8486
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00054599 | Other | UT | RAILROAD MEDICARE |
| 1054555 | Other | UT | NCCPA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51877361206 | UT | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1124061155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1160 E 3900 S",
"address_2": "#5000",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841241275",
"telephone_number": "801-262-8486",
"fax_number": "801-262-9752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1160 E 3900 S",
"address_2": "#5000",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841241275",
"telephone_number": "801-262-8486",
"fax_number": "801-262-9752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROPER",
"first_name": "STEPHEN",
"middle_name": "G",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "51877361206",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00054599",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCCPA",
"identifier": "1054555",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.