Active NPI
Katelyn Perry
- Physician Assistant
- Lehi, UT
National Provider Identifier
1750017794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 13028721-1206
- Practice address
- 2183 W Main St Ste A107
Lehi, UT 84043-6761 - Phone
- (385) 203-1215
- NPI assigned
- Jul 30, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | 13028721-1206 | UT | Primary |
Addresses
Primary practice location
2183 W Main St Ste A107
Lehi, UT 84043-6761
Mailing address
1055 N 500 W
Attn Credentialing
Provo, UT 84604
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2183 W Main St
Suite A107
Lehi, UT 84043-6761
Phone (801) 418-0810
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13028721-1206 | UT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revere Health PC | Current | Accepting new patients | |
| Revere Health PC | Current | Accepting new patients |
Locations
2183 W Main St
Ste A107
Lehi, UT 84043
Phone (385) 203-1215
1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000
Interoperability endpoints
- katelynperry@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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670457600000",
"number": "1750017794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 N 500 W",
"address_2": "ATTN CREDENTIALING",
"city": "PROVO",
"state": "UT",
"postal_code": "84604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2183 W MAIN ST STE A107",
"city": "LEHI",
"state": "UT",
"postal_code": "840436761",
"telephone_number": "385-203-1215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERRY",
"first_name": "KATELYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-07-30",
"last_updated": "2022-12-08",
"certification_date": "2022-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "13028721-1206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lehi, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; 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.