Individual provider Active NPI

Quinn William Legere

  • Physician Assistant
  • American Fork, UT
National Provider Identifier
1619725371
Registry record updated Oct 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11546662-1206 Issued in UT
Practice address
1175 E 50 S Ste 141
American Fork, UT 84003-2845
Phone
(801) 492-5996
Fax
(801) 492-5993
NPI assigned
May 8, 2024
Last updated
Oct 28, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2025

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 11546662-1206 UT Primary

Addresses

Primary practice location

1175 E 50 S Ste 141
American Fork, UT 84003-2845

Mailing address

1055 N 500 W
Provo, UT 84604-3305
Phone (801) 354-8225

Other practice location 1

555 W Sr 164
Salem, UT 84653-5732
Phone (801) 812-4624

Other practice location 2

2825 E Mall Dr
St George, UT 84790-1954
Phone (435) 986-2238

Other practice location 3

3000 N Triumph Blvd Ste 100
Lehi, UT 84043-7186
Phone (385) 345-3155

Other practice location 4

1055 N 500 W Ste 112
Provo, UT 84604-3305
Phone (801) 812-4624

Other practice location 5

1776 N Highway 40
Heber, UT 84032
Phone (801) 812-4624

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
I20251111001841 UT Practitioner - Physician Assistant 9133610868 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Revere Health PCGroup PAC ID 7517868508, 407 clinicians

Practice addresses (Care Compare)

1175 E 50
Suite 141
American Fork, UT 84003-2845
Phone (801) 492-5996

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11546662-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Revere Health PC CurrentSince Oct 1, 2025 Accepting new patients
Revere Health PC CurrentSince Oct 1, 2025 Accepting new patients

Locations

1175 E 50 S
Ste 141
American Fork, UT 84003
Phone (801) 492-5996

1776 N Highway 40
Heber City, UT 84032
Phone (801) 812-4624

1776 N Highway 40
Ste 112
Heber City, UT 84032

3000 N Triumph Blvd
Ste 100
Lehi, UT 84043
Phone (385) 345-3155

3000 N Triumph Blvd
Ste 112
Lehi, UT 84043

1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000

1055 N 500 W
Bldg C
Provo, UT 84604
Phone (801) 812-4624

1055 N 500 W
Ste 112
Provo, UT 84604
Phone (801) 812-4624

555 W State Road 164
Salem, UT 84653
Phone (801) 465-4896

555 W State Road 164
Ste 112
Salem, UT 84653

2825 E Mall Dr
St George, UT 84790
Phone (435) 673-6131

2825 E Mall Dr
Ste 112
St George, UT 84790

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1715126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761609600000",
    "number": "1619725371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 E 50 S STE 141",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840032845",
            "telephone_number": "801-492-5996",
            "fax_number": "801-492-5993"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "555 W SR 164",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "UT",
            "postal_code": "846535732",
            "country_code": "US",
            "telephone_number": "801-812-4624",
            "fax_number": "801-812-4699",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2825 E Mall Dr",
            "address_purpose": "LOCATION",
            "city": "St George",
            "state": "UT",
            "postal_code": "847901954",
            "country_code": "US",
            "telephone_number": "435-986-2238",
            "fax_number": "435-986-2237",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3000 N Triumph Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Lehi",
            "state": "UT",
            "postal_code": "840437186",
            "country_code": "US",
            "telephone_number": "385-345-3155",
            "fax_number": "385-345-3163",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1055 N 500 W Ste 112",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846043305",
            "country_code": "US",
            "telephone_number": "801-812-4624",
            "fax_number": "801-812-4699",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1776 N Highway 40",
            "address_purpose": "LOCATION",
            "city": "Heber",
            "state": "UT",
            "postal_code": "84032",
            "country_code": "US",
            "telephone_number": "801-812-4624",
            "fax_number": "801-812-4649",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEGERE",
        "first_name": "QUINN",
        "middle_name": "WILLIAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-08",
        "last_updated": "2025-10-28",
        "certification_date": "2025-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "11546662-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in American Fork, UT

Sources for this page

Verify at the official NPI Registry.