Individual provider Active NPI

Tress Sophia Keogh

  • Physician Assistant
  • Salt Lake City, UT
National Provider Identifier
1245967199
Registry record updated May 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13030982-1206 Issued in UT
Practice address
3723 S 645 E
Salt Lake City, UT 84106-1147
Phone
(704) 999-8743
NPI assigned
Aug 2, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 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 13030982-1206 UT Primary

Addresses

Primary practice location

3723 S 645 E
Salt Lake City, UT 84106-1147

Mailing address

3723 S 645 E
Salt Lake City, UT 84106-1147
Phone (704) 999-8743

Other identifiers 1

IdentifierTypeStateIssuer
NAOtherSTUDENT

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL na Other
Direct Messaging Address tkeogh618106@direct.med.utah.edu Direct University of Utah

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
I20230308002853 UT Practitioner - Physician Assistant 3577936715 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

1950 Circle of Hope Dr
Salt Lake City, UT 84112-5500
Phone (801) 581-2121

50 N Medical Dr
Salt Lake City, UT 84132-0001
Phone (801) 581-2121

50 N Medical Dr
Salt Lake City, UT 84132-0100
Phone (801) 213-2995

Hospital & facility affiliations

  • University of Utah Hospital and Clinics Hospital, Salt Lake City, UT, CCN 460009

Merit-based Incentive Payment System (MIPS)

Final score
89.77 of 100Reported as group
Quality
91.47
Promoting interoperability
100
Improvement activities
40
Cost
74.42

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13030982-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services CurrentSince Mar 1, 2023 Accepting new patients
University of Utah Adult Services CurrentSince Mar 1, 2023 Accepting new patients

Locations

127 S 500 E
Ste 400B
Salt Lake City, UT 84102
Phone (801) 587-6478

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Organizations & group practices 3

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 3

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": "1659398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682985600000",
    "number": "1245967199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3723 S 645 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841061147",
            "telephone_number": "704-999-8743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3723 S 645 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841061147",
            "telephone_number": "704-999-8743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEOGH",
        "first_name": "TRESS",
        "middle_name": "SOPHIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-02",
        "last_updated": "2023-05-02",
        "certification_date": "2023-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "13030982-1206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STUDENT",
            "identifier": "NA",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "na",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "NA",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "NA",
            "address_1": "3723 S 645 E",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841061147",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tkeogh618106@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.