Active NPI
Tyson Wilcox
- Physician Assistant
- Draper, UT
National Provider Identifier
1194379040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 11593 S Douglas Vista Dr
Draper, UT 84020-1480 - Phone
- (801) 592-7884
- NPI assigned
- Jul 30, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 | Primary |
Addresses
Primary practice location
11593 S Douglas Vista Dr
Draper, UT 84020-1480
Mailing address
11593 S Douglas Vista Dr
Draper, UT 84020-1480
Phone (801) 592-7884
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220117000023 | UT | Practitioner - Physician Assistant | 1759773179 | Reassigns benefits to 3 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Togo Healthcare LLC
Practice addresses (Care Compare)
1218 W S Jordan Pkwy
Suite B
South Jordan, UT 84095-5517
Phone (801) 592-7884
406 W S Jordan Pkwy
Suite 450
South Jordan, UT 84095-3946
Phone (801) 561-8398
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Togo Healthcare LLC | Single Specialty | Current | Accepting new patients |
| Ihc Health Services Inc | Single Specialty | Current | Accepting new patients |
| Ihc Health Services, Inc. | Current | Accepting new patients | |
| Vitality Togo | Past | Accepting new patients |
Locations
700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555
406 W South Jordan Pkwy
Ste 450
South Jordan, UT 84095
Phone (801) 561-8398
Organizations & group practices 6
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.
-
- Maternal & Fetal Medicine Physician
- St George, UT
- NPI 1093013203
Single Specialty
-
- Psychiatry Physician
- St George, UT
- NPI 1023843844
-
- Primary Care Clinic/Center
- South Jordan, UT
- NPI 1669252268
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703808000000",
"number": "1194379040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11593 S DOUGLAS VISTA DR",
"city": "DRAPER",
"state": "UT",
"postal_code": "840201480",
"telephone_number": "801-592-7884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11593 S DOUGLAS VISTA DR",
"city": "DRAPER",
"state": "UT",
"postal_code": "840201480",
"telephone_number": "801-592-7884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILCOX",
"first_name": "TYSON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-07-30",
"last_updated": "2023-12-29",
"certification_date": "2023-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Draper, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 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.