Individual provider Active NPI

Ethan Michael Young, PA

  • Physician Assistant
  • Riverton, UT
National Provider Identifier
1124590229
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12384125-1206 Issued in UT
Practice address
3723 W 12600 S Ste 430
Riverton, UT 84065-7310
Phone
(801) 285-4200
NPI assigned
Dec 30, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 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 12384125-1206 UT Primary
Medical Physician Assistant 363AM0700X

Addresses

Primary practice location

3723 W 12600 S Ste 430
Riverton, UT 84065-7310

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 706-1152

Other practice location 1

7170 Smoke Ranch Rd Ste 110
Las Vegas, NV 89128-3569
Phone (702) 463-3333

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
I20220223001763 UT Practitioner - Physician Assistant 3779821681 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

1034 N 500
Provo, UT 84604-3380
Phone (801) 357-8879

395 W Bulldog Blvd
Provo, UT 84604-3311

700 S Hwy 99
Suite 3
Fillmore, UT 84631-5137
Phone (801) 357-4600

765 E Marker Place Dr
Spanish Fork, UT 84660-1396
Phone (385) 344-5651

819 E Market Place Dr
Spanish Fork, UT 84660-1396
Phone (801) 357-7420

Hospital & facility affiliations

  • Intermountain Health Utah Valley Hospital Hospital, Provo, UT, CCN 460001
  • Intermountain Health Spanish Fork Hospital Hospital, Spanish Fork, UT, CCN 460062
  • Intermountain Health Sanpete Valley Hospital Hospital, Mount Pleasant, UT, CCN 461303
  • American Fork Hospital Hospital, American Fork, UT, CCN 460023

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Dec 27, 2021 Accepting new patients
Ihc Health Services Inc CurrentSince Dec 27, 2021 Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

98 N 1100 E
Ste 302
American Fork, UT 84003
Phone (801) 357-7081

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

395 W Cougar Blvd
Provo, UT 84604
Phone (801) 357-4141

395 W Cougar Blvd
Ste 503
Provo, UT 84604
Phone (801) 357-4600

3723 W 12600 S
Ste 430
Riverton, UT 84065
Phone (801) 285-4200

819 E Market Place Dr
Spanish Fork, UT 84660
Phone (385) 344-6600

819 E Market Place Dr
Ste 2C
Spanish Fork, UT 84660

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 6

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": "1546128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1124590229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-706-1152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3723 W 12600 S STE 430",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840657310",
            "telephone_number": "801-285-4200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7170 Smoke Ranch Rd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891283569",
            "country_code": "US",
            "telephone_number": "702-463-3333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "ETHAN",
        "middle_name": "MICHAEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-30",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "12384125-1206",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverton, UT

Sources for this page

Verify at the official NPI Registry.