Kevin Brantley Wise, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

13005654-1205 Issued in UT

Practice address

1200 E 3900 S Ste 4E
Millcreek, UT 84124-1300

Phone

(385) 347-3773

NPI assigned

Jun 21, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

Vanderbilt University School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Intensive Care Consortium IncGroup PAC ID 0244269413, 485 clinicians

Urgent Specialty Associates of Utah PLLCGroup PAC ID 3476904442, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Mark'S Hospital Hospital, Salt Lake City, UT, CCN 460047
• Northeastern Nevada Regional Hospital Hospital, Elko, NV, CCN 290008

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Urgent Specialty Associates of Utah PLLC

  • Surgical Critical Care Physician
  • Salt Lake City, UT
  • NPI 1992587778
  Medicare reassignment Care Compare group NPD
• Intensive Care Consortium Inc

  • Specialist
  • Aventura, FL
  • NPI 1629019062

  UT

  Medicare reassignment Care Compare group NPD
• Mountainstar Medical Group Neurosurgery - St Marks LLC

  • Neurological Surgery Physician
  • Salt Lake City, UT
  • NPI 1578859831
  NPD
• Urgent Specialty Associates of Utah PLLC

  • Surgical Critical Care Physician
  • Salt Lake City, UT
  • NPI 1871375659
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northern Utah Healthcare Corporation

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1164469243
  Care Compare affiliation
• PHC-Elko Inc

  • Rural Acute Care Hospital
  • Elko, NV
  • NPI 1770674350
  Care Compare affiliation

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

{
    "created_epoch": "1308614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680134400000",
    "number": "1427344233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 E 3900 S STE 4E",
            "city": "MILLCREEK",
            "state": "UT",
            "postal_code": "841241343",
            "telephone_number": "385-347-3773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E 3900 S STE 4E",
            "city": "MILLCREEK",
            "state": "UT",
            "postal_code": "841241300",
            "telephone_number": "385-347-3773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "KEVIN",
        "middle_name": "BRANTLEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-21",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "55513",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "UT",
            "license": "13005654-1205",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "TX",
            "license": "Q8190",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "UT",
            "license": "13005654-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffery Dale Whiten Jr., RBT
• Kathy Wickersham
• Wilde Heart PT LLC
• Rebekah Lee Rough Williamson
• Amanda Hardman Wilson, LCSW
• Niki Wolfe, CMHC
• Woodhaven at Millcreek Psychotherapy Services
• Rachel Wright
• Derrein Sharron Wynn
• Alessandra R Young, DAC, DAOM

• Surgery Physician in Millcreek, UT
• Providers in Millcreek, UT by specialty
• Surgery Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 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.