Cody Brad Mickelsen, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

9806425-1205 Issued in UT

Practice address

560 W 465 N Ste 604
Providence, UT 84332-8006

Phone

(435) 753-1600

NPI assigned

Apr 6, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Anesthesiology

Education

University of Vermont College of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Interwest Anesthesia Associates LLCGroup PAC ID 0042293359, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health Logan Regional Hospital Hospital, Logan, UT, CCN 460015
• Cache Valley Hospital Hospital, North Logan, UT, CCN 460054

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Interwest Anesthesia Associates LLC

  • Anesthesiology Physician
  • Providence, UT
  • NPI 1841214483
  Medicare reassignment Care Compare group NPD
• Anesthesia Associates of Great Falls LLC

  • Anesthesiology Physician
  • Great Falls, MT
  • NPI 1922007202
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ihc Health Services Inc

  • General Acute Care Hospital
  • Logan, UT
  • NPI 1831108497
  Care Compare affiliation
• Mountain Division - CVH, LLC

  • General Acute Care Hospital
  • North Logan, UT
  • NPI 1952703472
  Care Compare affiliation

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

{
    "created_epoch": "1238976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784764800000",
    "number": "1013159003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 W 465 N STE 604",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843328006",
            "telephone_number": "435-753-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 W 465 N STE 604",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843328006",
            "telephone_number": "435-753-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELSEN",
        "first_name": "CODY",
        "middle_name": "BRAD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-06",
        "last_updated": "2026-07-23",
        "certification_date": "2026-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "9806425-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul D. McOmber, PA-C
• Sarah Grace McTaggart, RBT
• Jessica Jolley Mecklenburg, RBT
• Emma Merriam, RBT
• Emma Micheel, RBT
• Rebecca Lyn Miles, RBT
• Momentum Behavior Consulting LLC
• Cari Monson, RBT-24-382762
• Matthew Stephen Morrell, PA-C
• Wesley S Mortensen, MD

• Anesthesiology Physician in Providence, UT
• Providers in Providence, UT by specialty
• Anesthesiology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.

Verify at the official NPI Registry.