Individual provider Active NPI

Elizabeth Wright Timothy, PA

  • Medical Physician Assistant
  • Draper, UT
National Provider Identifier
1760825582
Registry record updated Mar 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
85901811206 Issued in UT
Practice address
12176 S 1000 E Ste 4
Draper, UT 84020-3221
Phone
(801) 572-3750
NPI assigned
Apr 10, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 85901811206 UT Primary

Addresses

Primary practice location

12176 S 1000 E Ste 4
Draper, UT 84020-3221

Mailing address

12176 S 1000 E Ste 4
Draper, UT 84020-3221
Phone (801) 572-3750

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
I20140226000945 UT Practitioner - Physician Assistant 7719117373 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hidden Valley Family Medicine IncGroup PAC ID 5294899456, 7 clinicians

Practice addresses (Care Compare)

12176 S 1000
Suite 4
Draper, UT 84020-3221
Phone (801) 572-3750

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
85901811206UTMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ronald F Lopez MD LLC Current Accepting new patients

Locations

12176 S 1000 E
Ste 4
Draper, UT 84020
Phone (801) 572-3750

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": "1365552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678838400000",
    "number": "1760825582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12176 S 1000 E STE 4",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840203221",
            "telephone_number": "801-572-3750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12176 S 1000 E STE 4",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840203221",
            "telephone_number": "801-572-3750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIMOTHY",
        "first_name": "ELIZABETH",
        "middle_name": "WRIGHT",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-10",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "85901811206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Draper, UT

Sources for this page

Verify at the official NPI Registry.