Kelly D Mikesell, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5244260-1206 Issued in UT

Practice address

3570 W 9000 S Ste 200
West Jordan, UT 84088-8875

Phone

(801) 566-9211

Fax

(801) 566-5667

NPI assigned

Aug 15, 2007

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ogden Clinic Specialty Services LLCGroup PAC ID 1658781422, 131 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health McKay-Dee Hospital Hospital, Ogden, UT, CCN 460004
• Holy Cross Hospital-Davis Hospital, Layton, UT, CCN 460041
• Ogden Regional Medical Center Hospital, Ogden, UT, CCN 460005
• Intermountain Health Layton Hospital Hospital, Layton, UT, CCN 460061

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Ogden Clinic Specialty Services LLC

  • Sports Medicine (Family Medicine) Physician
  • Ogden, UT
  • NPI 1114203668
  Medicare reassignment Care Compare group
• Ogden Clinic PC

  • Family Medicine Physician
  • Ogden, UT
  • NPI 1578550083
  NPD
• Revere Health PC

  • Multi-Specialty Clinic/Center
  • Spanish Fork, UT
  • NPI 1851142285
  NPD (past)

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

• Catholic Health Initiatives Colorado

  • General Acute Care Hospital
  • Layton, UT
  • NPI 1346945839
  Care Compare affiliation
• Columbia Ogden Medical Center, Inc.

  • General Acute Care Hospital
  • Ogden, UT
  • NPI 1720031636
  Care Compare affiliation
• Ihc Health Services Inc

  • General Acute Care Hospital
  • Ogden, UT
  • NPI 1194749580
  Care Compare affiliation
• Ihc Health Services, Inc.

  • General Acute Care Hospital
  • Layton, UT
  • NPI 1417460205
  Care Compare affiliation

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

{
    "created_epoch": "1187136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486598400000",
    "number": "1023200888",
    "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",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3570 W 9000 S STE 200",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840888875",
            "telephone_number": "801-566-9211",
            "fax_number": "801-566-5667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKESELL",
        "first_name": "KELLY",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-15",
        "last_updated": "2017-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "5244260-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheri E Meyer, OD
• Michael L Taylor Anesthesiology PLLC
• Gary F Michaels
• Microculture, Inc.
• Sarah Jane Midgley
• Jessica Millard
• Miller Anesthesia Consultants PC
• Kaitlyn Amanda Miller-Stith
• Andrew A Miller, CRNA
• Chelsey Miller, FNP-C

• Medical Physician Assistant in West Jordan, UT
• Providers in West Jordan, UT by specialty
• Medical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2017; 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.