Individual provider Active NPI

KC Hafen, PA

  • Physician Assistant
  • St George, UT
National Provider Identifier
1194740522
Registry record updated Oct 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2849081206 Issued in UT
Practice address
652 South Medical Center Drive
Suite 400
St George, UT 84790
Phone
(435) 251-2650
NPI assigned
Jul 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2849081206 UT Primary

Addresses

Primary practice location

652 South Medical Center Drive
Suite 400
St George, UT 84790

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (435) 251-2650

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
I20040112000251 UT Practitioner - Physician Assistant 3577462480 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

1380 E Medical Ctr Dr
Suite 1400
St George, UT 84790-2127
Phone (435) 251-2600

2075 N 1200
Layton, UT 84041-1611
Phone (801) 779-6200

2075 University Park Blvd
Layton, UT 84041-1611
Phone (801) 387-6200

5323 S Woodrow St
Murray, UT 84107-5841
Phone (801) 261-8346

652 S Medical Ctr Dr
St George, UT 84790-7049

700 S Hwy 99
Suite 3
Fillmore, UT 84631-5137
Phone (801) 357-4600

9450 S 1300
Sandy, UT 84094-5555
Phone (801) 501-6250

Hospital & facility affiliations

  • St. George Regional Hospital Hospital, St George, UT, CCN 460021

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
598NVMDAddiction (Substance Use Disorder) Counselor
2849081206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince May 15, 2005 Accepting new patients
Health Services Inc CurrentSince May 15, 2005 Accepting new patients

Locations

6 Steptoe Cir
Ely, NV 89301
Phone (775) 289-3001

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

75 N 2260 W
Hurricane, UT 84737
Phone (435) 635-6400

1380 E Medical Center Dr
Ste 2100
St George, UT 84790
Phone (435) 251-2650

652 S Medical Center Dr
Ste 120
St George, UT 84790
Phone (435) 251-3600

652 S Medical Center Dr
Ste 400
St George, UT 84790
Phone (435) 251-2650

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254873600000",
    "number": "1194740522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "435-251-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "652 SOUTH MEDICAL CENTER DRIVE",
            "address_2": "SUITE 400",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "84790",
            "telephone_number": "435-251-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAFEN",
        "first_name": "KC",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2009-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "2849081206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St George, UT

Sources for this page

Verify at the official NPI Registry.