Emilse Antonio Peraza, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6777964-1206 Issued in UT

Practice address

1045 E 3900 S
Salt Lake City, UT 84124-1100

Phone

(801) 261-2000

Fax

(801) 262-5304

NPI assigned

Oct 13, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Electronic endpoints 1

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

Specialty

Physician Assistant

Education

University of Utah School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Utah Community Physicians GroupGroup PAC ID 9739403569, 277 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: emilse.peraza.1@13794.direct.athenahealth.com

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.

• University of Utah Community Physicians Group

  • Family Medicine Physician
  • Salt Lake City, UT
  • NPI 1467241554
  Medicare reassignment Care Compare group
• Exodus Healthcare Network PLLC

  • Family Medicine Physician
  • Magna, UT
  • NPI 1306952783
  Medicare reassignment
• University of Utah Community Physicians Group

  • General Practice Physician
  • Salt Lake City, UT
  • NPI 1124422126
  NPD
• University of Utah Community Physicians Group

  • Family Medicine Physician
  • Park City, UT
  • NPI 1053715763
  NPD (past)

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

• University of Utah

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1487734976
  Care Compare affiliation
• University of Utah

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1588656870
  Care Compare affiliation
• University of Utah

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1699889576
  Care Compare affiliation

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

{
    "created_epoch": "1318464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689292800000",
    "number": "1619252384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 E 3900 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241100",
            "telephone_number": "801-261-2000",
            "fax_number": "801-262-5304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 E 3900 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241100",
            "telephone_number": "801-261-2000",
            "fax_number": "801-262-5304"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "925 Wells Avenue",
            "address_purpose": "LOCATION",
            "city": "W. Wendover",
            "state": "NV",
            "postal_code": "89883",
            "country_code": "US",
            "telephone_number": "775-664-2220",
            "fax_number": "775-664-2965",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "925 Wells Avenue",
            "address_purpose": "LOCATION",
            "city": "W. Wendover",
            "state": "NV",
            "postal_code": "89883",
            "country_code": "US",
            "telephone_number": "775-664-2220",
            "fax_number": "775-664-2965",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PERAZA",
        "first_name": "EMILSE",
        "middle_name": "ANTONIO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-13",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-03160",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA1364",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "6777964-1206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC MEDICAL LICENSE",
            "identifier": "0010-03160",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UT PA LICENSE",
            "identifier": "6777964-1206",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NV PA LICENSE",
            "identifier": "PA1364",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eperaza16735@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": []
}

• Samuel Noah Pepper
• Andrea Peralta
• Dana Lynn Peralta, MD
• Eliza Peralta
• Klerly Daniela Peralta
• Merideth Perches
• Madison C. Perchik, MD
• Theresa Marie Perdue
• Raquel Elan Perea
• Carole Ann Peretti, BCO BADO

• Physician Assistant in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 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.