Mark Overas, P.A.-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

8663450-1206 Issued in UT

Practice address

355 N Main St
Kanab, UT 84741-3260

Phone

(435) 644-4100

Fax

(435) 644-3366

NPI assigned

Mar 8, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Revere Health PC

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

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376524800000",
    "number": "1376511261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-812-4673",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 N MAIN ST",
            "city": "KANAB",
            "state": "UT",
            "postal_code": "847413260",
            "telephone_number": "435-644-4100",
            "fax_number": "435-644-3366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OVERAS",
        "first_name": "MARK",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2013-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "2756",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "8663450-1206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "762931",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Teri Lee Nielsen, LPC, CMHC
• Wade Nielson, DPT
• Wayne S Nielson, PA
• Melissa Joy Ohman
• Darin Dale Ott, D.O.
• Joanne Marie Palmer, F.N.P.
• Roger Patterson, LMT
• Sophia Elaine Perez, FNP
• Trenton James Petersen, PHARMD
• Deborah J Quient, PA

• All providers in Kanab, UT
• Medical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.