Individual provider Active NPI

Sean J Stucki, PA-C

  • Physician Assistant
  • St George, UT
National Provider Identifier
1245296383
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5178738-1206 Issued in UT
Practice address
2825 E Mall Dr
St George, UT 84790-1954
Phone
(435) 656-8800
Fax
(435) 627-1809
NPI assigned
Apr 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

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 5178738-1206 UT Primary

Addresses

Primary practice location

2825 E Mall Dr
St George, UT 84790-1954

Mailing address

1055 N 500 W
Attn: Credentialing
Provo, UT 84604-3305
Phone (801) 354-8225

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address medreview@reverehealth.com Central Utah Clinic, P.C.

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
I20130514000551 UT Practitioner - Physician Assistant 0941447767 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Revere Health PCGroup PAC ID 7517868508, 407 clinicians

Practice addresses (Care Compare)

2825 E Mall Dr
St George, UT 84790-1954
Phone (435) 673-6131

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Revere Health PC CurrentSince Jul 10, 2017 Accepting new patients
Revere Health PC CurrentSince Jul 10, 2017 Accepting new patients

Locations

1055 N 500 W
Ste 212
Provo, UT 84604
Phone (801) 374-2362

1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000

1424 E Foremaster Dr
Ste 120
St George, UT 84790
Phone (435) 656-8800

2825 E Mall Dr
St George, UT 84790
Phone (435) 673-6131

Interoperability endpoints

  • Direct secure messaging: seanstucki@cuccu.allscriptsdirect.net

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743033600000",
    "number": "1245296383",
    "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": "846043305",
            "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": "2825 E MALL DR",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847901954",
            "telephone_number": "435-656-8800",
            "fax_number": "435-627-1809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUCKI",
        "first_name": "SEAN",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "5178738-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Central Utah Clinic, P.C.",
            "address_1": "1424 E Foremaster Dr # 120",
            "city": "St George",
            "state": "UT",
            "country_code": "US",
            "postal_code": "847905832",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in St George, UT

Sources for this page

Verify at the official NPI Registry.