Bryan Ellis, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12537569-1206 Issued in UT

Practice address

680 E Main St Ste 201
Lehi, UT 84043-2251

Phone

(801) 768-8800

NPI assigned

Nov 1, 2021

Last updated

Feb 10, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Utah Valley Dermatology PCGroup PAC ID 7113181355, 11 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Utah Valley Dermatology PC

  • Dermatology Physician
  • Lehi, UT
  • NPI 1922368927
  Medicare reassignment Care Compare group
• Southwest Spine and Pain Care Specialists, LLC

  dba Vista Spine Sports and Injury Center

  • Chiropractor
  • St George, UT
  • NPI 1871263178
  NPD (past)

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

{
    "created_epoch": "1635724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675987200000",
    "number": "1174288575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13658 S FORT ST",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840209278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 E MAIN ST STE 201",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840432251",
            "telephone_number": "801-768-8800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1055 N 300 W Ste 303",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846043373",
            "country_code": "US",
            "telephone_number": "801-768-8800",
            "fax_number": "801-820-8200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "62 E Thrive Dr Ste 220",
            "address_purpose": "LOCATION",
            "city": "Saratoga Springs",
            "state": "UT",
            "postal_code": "840455560",
            "country_code": "US",
            "telephone_number": "801-768-8800",
            "fax_number": "801-820-8200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "BRYAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-01",
        "last_updated": "2023-02-10",
        "certification_date": "2023-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "12537569-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elite Home Health Utah LLC
• Elite Hospice LLC
• Elite Transport of Utah, LLC
• Laurie Elkins, LCSW
• Kayla Ellingson, RN
• Morgan Ellis
• Jennifer Jeanine Ellstrom, FNP-C
• Aaron Scott Elswood, PA-C
• Jarrett Elswood
• Elva's Haven LLC

• Physician Assistant in Lehi, UT
• Providers in Lehi, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.