Individual provider Active NPI

Patricia Ellsworth, DNP

  • Nurse Practitioner
  • Layton, UT
National Provider Identifier
1578086740
Registry record updated Jun 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5232048-4405 Issued in UT
Practice address
2132 N 1700 W
Ste 110
Layton, UT 84041-7059
Phone
(801) 779-3500
Fax
(801) 779-3508
NPI assigned
Jul 19, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5232048-4405 UT
Nurse Practitioner 363L00000X 5232048-4405 UT Primary
Registered Nurse 163W00000X 5232048 UT

Addresses

Primary practice location

2132 N 1700 W
Ste 110
Layton, UT 84041-7059

Mailing address

2344 N 840 W
Clinton, UT 84015-9726
Phone (801) 540-2698

Other identifiers 1

IdentifierTypeStateIssuer
1578086740MedicaidUT

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address PELLSWORTH579651@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
I20171122000097 UT Practitioner - Nurse Practitioner 0547527871 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5232048UTMDRegistered Nurse
5232048-4405UTMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Pediatric Services CurrentSince Mar 1, 2022 Accepting new patients
University of Utah Pediatric Services CurrentSince Mar 1, 2022 Accepting new patients
University of Utah Pediatric Services Current Accepting new patients
University of Utah Pediatric Services Past Accepting new patients
Kidney & Hypertension Institute of Northern Utah LLC Past Accepting new patients

Locations

81 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 662-5700

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

100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1500422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654041600000",
    "number": "1578086740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2344 N 840 W",
            "city": "CLINTON",
            "state": "UT",
            "postal_code": "840159726",
            "telephone_number": "801-540-2698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2132 N 1700 W",
            "address_2": "STE 110",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840417059",
            "telephone_number": "801-779-3500",
            "fax_number": "801-779-3508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "PATRICIA",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-19",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "5232048-4405",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "5232048-4405",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "UT",
            "license": "5232048",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578086740",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "PELLSWORTH579651@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 Layton, UT

Sources for this page

Verify at the official NPI Registry.