Individual provider Active NPI

William Brian Wegesser, PA-C

  • Physician Assistant
  • Salt Lake City, UT
National Provider Identifier
1174724579
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
107093-1206 Issued in UT
Practice address
8TH Avenue and C St
LDSH Hospital, East 8
Salt Lake City, UT 84143-0001
Phone
(801) 408-3623
Fax
(801) 408-8578
NPI assigned
May 31, 2007
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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 107093-1206 UT Primary

Addresses

Primary practice location

8TH Avenue and C St
LDSH Hospital, East 8
Salt Lake City, UT 84143-0001

Mailing address

8TH Avenue and C St
LDS Hospital, East 8
Salt Lake City, UT 84143-0001
Phone (801) 408-3623

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

LicenseStateTypeSpecialty
107093-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Department of Pediatrics University of Utah Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1174724579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8TH AVENUE AND C ST",
            "address_2": "LDS HOSPITAL, EAST 8",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841430001",
            "telephone_number": "801-408-3623",
            "fax_number": "801-408-8578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8TH AVENUE AND C ST",
            "address_2": "LDSH HOSPITAL, EAST 8",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841430001",
            "telephone_number": "801-408-3623",
            "fax_number": "801-408-8578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEGESSER",
        "first_name": "WILLIAM",
        "middle_name": "BRIAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-31",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "107093-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "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.

Verify at the official NPI Registry.