NPIMap

Individual provider Active NPI

John Richard Welsh Kestle, MD

  • Neurological Surgery Physician
  • Salt Lake City, UT
National Provider Identifier
1871683474
Registry record updated Nov 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
360219-1205 Issued in UT
Practice address
100 Mario Capecchi Dr
Suite 1475
Salt Lake City, UT 84113-1103
Phone
(801) 662-5340
Fax
(801) 662-5345
NPI assigned
Oct 13, 2006
Last updated
Nov 3, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 360219-1205 UT Primary

Addresses

Primary practice location

100 Mario Capecchi Dr
Suite 1475
Salt Lake City, UT 84113-1103

Mailing address

PO Box 58417
Salt Lake City, UT 84158-0417
Phone (801) 213-3800

Other identifiers 1

IdentifierTypeStateIssuer
1871683474MedicaidUT

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jkestle49521@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100924000852 UT Practitioner - Pediatric MedicinePractitioner - Neurosurgery 4385760586 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Jul 4, 2010 Accepting new patients
University of Utah Surgical Services Neurological Surgery CurrentSince Feb 1, 2015 Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Surgical Services Current Accepting new patients
University of Utah Pediatric Services CurrentSince Jan 12, 2019 Accepting new patients
University of Utah Pediatric Services Current Accepting new patients
Ihc Health Services Inc CurrentSince Jul 4, 2010 Accepting new patients
University of Utah Adult Services CurrentSince Feb 1, 2015 Accepting new patients
Ihc Health Services Inc Family Medicine Current Accepting new patients
University of Utah Adult Services CurrentSince Feb 1, 2015 Accepting new patients
University of Utah Surgical Services CurrentSince Feb 1, 2015 Accepting new patients
University of Utah Pediatric Services CurrentSince Jan 12, 2019 Accepting new patients
University of Utah Pediatric Services Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

5770 S 250 E
Ste 210
Salt Lake City, UT 84107
Phone (801) 314-4544

100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

81 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 662-5700

1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

Organizations & group practices 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1871683474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 58417",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841580417",
            "telephone_number": "801-213-3800",
            "fax_number": "801-585-3655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MARIO CAPECCHI DR",
            "address_2": "SUITE 1475",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-662-5340",
            "fax_number": "801-662-5345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KESTLE",
        "first_name": "JOHN",
        "middle_name": "RICHARD WELSH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "UT",
            "license": "360219-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871683474",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jkestle49521@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.