Individual provider Active NPI

Maddison Heyn, PA-C

  • Physician Assistant
  • Provo, UT
National Provider Identifier
1215448071
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10503964-1206 Issued in UT
Practice address
395 W Cougar Blvd Ste B
Provo, UT 84604-3311
Phone
(801) 373-3300
Fax
(801) 354-7900
NPI assigned
Oct 19, 2017
Last updated
Sep 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10503964-1206 UT Primary
Pediatrics Physician 208000000X 10503964-1206 UT

Addresses

Primary practice location

395 W Cougar Blvd Ste B
Provo, UT 84604-3311

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128

Other practice location 1

1912 W 930 N
Pleasant Grove, UT 84062-4104
Phone (801) 492-1999

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
I20220808002104 UT Practitioner - Physician Assistant 5698157667 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, shared by 68 NPIs, 3,948 clinicians

Practice addresses (Care Compare)

395 W Bulldog Blvd
Provo, UT 84604-3331

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10503964-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Apr 9, 2022 Accepting new patients
Ihc Health Services Inc CurrentSince Jul 26, 2024 Accepting new patients
Ihc Health Services Inc CurrentSince Apr 9, 2022 Accepting new patients
Ihc Health Services Inc Family Medicine CurrentSince Sep 8, 2024 Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

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

395 W Cougar Blvd
Ste 603
Provo, UT 84604
Phone (801) 357-1722

395 W Cougar Blvd
Ste B
Provo, UT 84604
Phone (801) 373-3300

400 C St
Salt Lake Cty, UT 84143
Phone (435) 688-4080

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1508371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1215448071",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 W COUGAR BLVD STE B",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043311",
            "telephone_number": "801-373-3300",
            "fax_number": "801-354-7900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1912 W 930 N",
            "address_purpose": "LOCATION",
            "city": "Pleasant Grove",
            "state": "UT",
            "postal_code": "840624104",
            "country_code": "US",
            "telephone_number": "801-492-1999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEYN",
        "first_name": "MADDISON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-19",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "10503964-1206",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "10503964-1206",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.