Individual provider Active NPI

Justin Douglas Wiliiams, CRNA

  • Certified Registered Nurse Anesthetist
  • Heber City, UT
National Provider Identifier
1285671446
Registry record updated Aug 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
355105-4406 Issued in UT
Practice address
454 E Medical Way
Heber City, UT 84032-1391
Phone
(435) 658-6738
NPI assigned
May 31, 2006
Last updated
Aug 25, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 355105-4406 UT Primary

Addresses

Primary practice location

454 E Medical Way
Heber City, UT 84032-1391

Mailing address

PO Box 30180
Salt Lake City, UT 84130-0180
Phone (435) 658-6738

Other identifiers 1

IdentifierTypeStateIssuer
911387900MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080319000180 UT Practitioner - Certified Registered Nurse Anesthetist (Crna) 2769481829 Reassigns benefits to 3 organizations
I20100312000308 AZ Practitioner - Certified Registered Nurse Anesthetist (Crna) 2769481829 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Anesthesia LLCGroup PAC ID 9234438649, 4 clinicians

Practice addresses (Care Compare)

454 E Medical Way
Heber City, UT 84032-1391
Phone (435) 654-2500

501 N Navajo
Page, AZ 86040
Phone (928) 645-2424

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
074792MOMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services Inc CurrentSince Aug 1, 2007 Accepting new patients
Mountain West Anesthesia LLC Anesthesiology CurrentSince Jun 1, 2022 Accepting new patients
Ihc Health Services, Inc. CurrentSince Aug 1, 2007 Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Sep 1, 2012 Accepting new patients
Page Hospital CurrentSince Sep 16, 2020 Accepting new patients
Page Hospital CurrentSince Sep 16, 2020 Accepting new patients
Legacy Anesthesia LLC Anesthesiology CurrentSince Nov 4, 2015 Accepting new patients
Banner Hospital Based Physicians Arizona LLC Current Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Sep 1, 2012 Accepting new patients
Verde Valley Medical Center Past Accepting new patients

Locations

454 E Medical Way
Heber City, UT 84032
Phone (435) 654-2500

900 Round Valley Dr
Park City, UT 84060
Phone (435) 658-7000

150 W Civic Center Dr
Ste 200
Sandy, UT 84070
Phone (801) 727-2056

1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

Organizations & group practices 11

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.

Hospital & facility affiliations 1

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": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787616000000",
    "number": "1285671446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30180",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841300180",
            "telephone_number": "435-658-6738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 E MEDICAL WAY",
            "city": "HEBER CITY",
            "state": "UT",
            "postal_code": "840321391",
            "telephone_number": "435-658-6738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILIIAMS",
        "first_name": "JUSTIN",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "UT",
            "license": "355105-4406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "911387900",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Heber City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.