Active NPI
Ronald R Ketelsen, PA-C
- Physician Assistant
- Salt Lake City, UT
National Provider Identifier
1659458339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 102163-1206
- Practice address
- 3981 Wasatch Blvd
Salt Lake City, UT 84124-2247 - Phone
- (801) 213-9500
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 102163-1206 | UT | Primary |
Addresses
Primary practice location
3981 Wasatch Blvd
Salt Lake City, UT 84124-2247
Mailing address
PO Box 510721
Salt Lake City, UT 84151-0721
Phone (801) 587-6600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102163-1206 | UT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Health Care Quick Clinic | Physician Assistant | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physician Assistant
- Holladay, UT
- NPI 1376645671
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659458339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 510721",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841510721",
"telephone_number": "801-587-6600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3981 WASATCH BLVD",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841242247",
"telephone_number": "801-213-9500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETELSEN",
"first_name": "RONALD",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "102163-1206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.