Active NPI
Benjamin T Dedrickson, PA-C
- Physician Assistant
- Layton, UT
National Provider Identifier
1710496047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10982649-1206
- Practice address
- 1580 W Antelope Dr Ste 110
Layton, UT 84041-1153 - Phone
- (801) 807-7699
- NPI assigned
- Sep 29, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 6854 | AZ | |
| Physician Assistant | 363A00000X | 10982649-1206 | UT | Primary |
Addresses
Primary practice location
1580 W Antelope Dr Ste 110
Layton, UT 84041-1153
Mailing address
1489 S Higley Rd Ste 101
Gilbert, AZ 85296-4777
Phone (480) 457-8800
Other practice location 1
1489 S Higley Rd Ste 101
Gilbert, AZ 85296-4777
Phone (480) 457-8800
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 |
|---|---|---|---|
| 10982649-1206 | UT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Onsite Care Inc | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1710496047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1489 S HIGLEY RD STE 101",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852964777",
"telephone_number": "480-457-8800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1580 W ANTELOPE DR STE 110",
"city": "LAYTON",
"state": "UT",
"postal_code": "840411153",
"telephone_number": "801-807-7699"
}
],
"practiceLocations": [
{
"address_1": "1489 S Higley Rd Ste 101",
"address_purpose": "LOCATION",
"city": "Gilbert",
"state": "AZ",
"postal_code": "852964777",
"country_code": "US",
"telephone_number": "480-457-8800",
"fax_number": "480-457-8885",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DEDRICKSON",
"first_name": "BENJAMIN",
"middle_name": "T",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-09-29",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "6854",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "10982649-1206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Layton, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.