Dustin Bryant Wise, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

52479661205 Issued in UT

Practice address

1888 W 800 N
Pleasant Grove, UT 84062-4097

Phone

(801) 492-7851

Fax

(801) 492-7883

NPI assigned

May 4, 2006

Last updated

Sep 9, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Sandy, UT
  • NPI 1942325154
  Medicare reassignment NPD
• Dustin B. Wise, M.D., P.C.

  dba Lone Peak Pediatrics

  • Pediatrics Physician
  • Pleasant Grove, UT
  • NPI 1932249299
  NPD (past) Authorized official
• Ihc Health Services Inc

  dba Orthopedic Specialty Group - Riverton Campus

  • Orthopaedic Surgery Physician
  • Riverton, UT
  • NPI 1952563579
  NPD
• Ihc Health Services, Inc.

  dba St George Adolescent Partial Hospitalization

  • Psychiatry Physician
  • St George, UT
  • NPI 1023843844
  NPD
• Ihc Health Services Inc

  dba Orem Community Hospital Physicians

  • Multi-Specialty Clinic/Center
  • Orem, UT
  • NPI 1588601124
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1811945769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1888 W 800 N",
            "city": "PLEASANT GROVE",
            "state": "UT",
            "postal_code": "84062",
            "telephone_number": "801-492-7851",
            "fax_number": "801-492-7883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1888 W 800 N",
            "city": "PLEASANT GROVE",
            "state": "UT",
            "postal_code": "840624097",
            "telephone_number": "801-492-7851",
            "fax_number": "801-492-7883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "DUSTIN",
        "middle_name": "BRYANT",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "52479661205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHC HEALTH PLANS",
            "identifier": "107017722102",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dustin.wise@direct.imail.org",
            "affiliation": "N",
            "address_1": "1888 W 800 N",
            "city": "Pleasant Grove",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840624097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pediatrics Physician in Pleasant Grove, UT
• Providers in Pleasant Grove, UT by specialty
• Pediatrics Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.