Active NPI
Karl N Weenig, MD
- Sports Medicine (Family Medicine) Physician
- Provo, UT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Family Medicine) Physician
- License
- 5376578-1205
- Practice address
- 1157 N 300 W Ste 201
Provo, UT 84604-6124 - Phone
- (801) 357-1200
- NPI assigned
- Apr 4, 2006
- Last updated
- Jun 2, 2026
- 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 |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 5376578-1205 | UT | Primary |
Addresses
Primary practice location
1157 N 300 W Ste 201
Provo, UT 84604-6124
Mailing address
PO Box 27128
Salt Lake City, UT 84127-0128
Other practice location 1
1055 N 500 W
Suite 121
Provo, UT 84604-3305
Phone (801) 373-7350
Other practice location 2
700 W 800 N Ste 100
Orem, UT 84057-6301
Phone (801) 373-7350
Other practice location 3
555 W Sr 164
Salem, UT 84653
Phone (801) 373-7350
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 870281028000 | Medicaid | UT | |
| 89048 | Other | UT | PEHP |
| 870281028KNW | Other | UT | EMIA |
| 870281028KWF | Other | UT | EMIA |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Bluemark LLC/ Office Ally | |
| Direct Messaging Address | medreview@reverehealth.com | Revere Health PC |
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Sports Medicine
- Education
- University of Utah School of Medicine, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1055 N 500
Provo, UT 84604-3305
Phone (801) 429-8000
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of nail tissue | 11 |
| Removal or shaving of skin growth | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revere Health PC | Current | Accepting new patients | |
| Revere Health PC | Current | Accepting new patients |
Locations
1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000
1055 N 500 W
Ste 121
Provo, UT 84604
Phone (801) 373-3750
1055 N 500 W
Ste 212
Provo, UT 84604
Phone (801) 374-2362
555 W State Road 164
Salem, UT 84653
Phone (801) 465-4896
Interoperability endpoints
- karlweenig@cuccu.allscriptsdirect.net
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": "1144108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780358400000",
"number": "1740242973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 27128",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841270128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1157 N 300 W STE 201",
"city": "PROVO",
"state": "UT",
"postal_code": "846046124",
"telephone_number": "801-357-1200"
}
],
"practiceLocations": [
{
"address_1": "1055 N 500 W",
"address_2": "Suite 121",
"address_purpose": "LOCATION",
"city": "Provo",
"state": "UT",
"postal_code": "846043305",
"country_code": "US",
"telephone_number": "801-373-7350",
"fax_number": "801-812-5401",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "700 W 800 N Ste 100",
"address_purpose": "LOCATION",
"city": "Orem",
"state": "UT",
"postal_code": "840576301",
"country_code": "US",
"telephone_number": "801-373-7350",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "555 W SR 164",
"address_purpose": "LOCATION",
"city": "Salem",
"state": "UT",
"postal_code": "84653",
"country_code": "US",
"telephone_number": "801-373-7350",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WEENIG",
"first_name": "KARL",
"middle_name": "N",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-04",
"last_updated": "2026-06-02",
"certification_date": "2026-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "207QS0010X",
"taxonomy_group": "",
"desc": "Family Medicine, Sports Medicine",
"state": "UT",
"license": "5376578-1205",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "870281028000",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEHP",
"identifier": "89048",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMIA",
"identifier": "870281028KNW",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMIA",
"identifier": "870281028KWF",
"state": "UT"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.2019.3",
"affiliationName": "Bluemark LLC/ Office Ally",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CMS esMD eMDR",
"address_1": "1300 SE Cardinal Ct Ste 190",
"city": "Vancouver",
"state": "WA",
"country_code": "US",
"postal_code": "986839683",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "medreview@reverehealth.com",
"affiliation": "Y",
"affiliationName": "Revere Health PC",
"address_1": "1055 N 500 W",
"address_2": "Suite 121",
"city": "Provo",
"state": "UT",
"country_code": "US",
"postal_code": "846043305",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; 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.