NPIMap

Individual provider Active NPI

Brandon S Hermansen, PA-C

  • Physician Assistant
  • Farmington, UT
National Provider Identifier
1508116450
Registry record updated Feb 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
6711038-1206 Issued in UT
Practice address
1433 N 1075 W Ste 104
Farmington, UT 84025-2746
Phone
(801) 298-1300
Fax
(801) 296-6199
NPI assigned
Sep 18, 2012
Last updated
Feb 26, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2019

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 6711038-1206 UT Primary

Addresses

Primary practice location

1433 N 1075 W Ste 104
Farmington, UT 84025-2746

Mailing address

PO Box 25488
Salt Lake City, UT 84125-0488
Phone (800) 475-3698

Other identifiers 3

IdentifierTypeStateIssuer
143659OtherUTPEHP
P01132445OtherUTRAILROAD MEDICARE
964305OtherUTWINDSOR HEALTH PLAN MEDICAREEXTRA/STERLING HEALTH PLAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130115000476 UT Practitioner - Physician Assistant 1658524053 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
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)

1034 N 500
Provo, UT 84604-3380

1380 E Medical Ctr Dr
St George, UT 84790-2123
Phone (435) 251-1000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Sep 1, 2019 Accepting new patients
Ihc Health Services Inc CurrentSince Sep 1, 2019 Accepting new patients
Perspective Counseling Services LLC PastSince Dec 1, 2025 Accepting new patients

Locations

1034 N 500 W
Provo, UT 84604
Phone (801) 362-4119

1055 N 300 W
Ste 104
Provo, UT 84604
Phone (801) 357-7525

1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

Organizations & group practices 4

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.

Hospital & facility affiliations 7

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": "1347926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551139200000",
    "number": "1508116450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25488",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841250488",
            "telephone_number": "800-475-3698",
            "fax_number": "801-296-6199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1433 N 1075 W STE 104",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252746",
            "telephone_number": "801-298-1300",
            "fax_number": "801-296-6199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERMANSEN",
        "first_name": "BRANDON",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-18",
        "last_updated": "2019-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "6711038-1206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "143659",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01132445",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WINDSOR HEALTH PLAN MEDICAREEXTRA/STERLING HEALTH PLAN",
            "identifier": "964305",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, UT

Sources for this page

Verify at the official NPI Registry.