Brent C Dawson, P.A.
Individual provider Active NPI Physician Assistant · Fortuna, CA
NPI 1548566276 · NPPES record last updated Jun 14, 2017
Key facts
- NPI
- 1548566276
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 8289902-1206 (UT)
- Practice address
- 3304 Renner Dr
Fortuna, CA 95540-7102 - Phone
- (707) 725-9383
- Fax
- (707) 725-1140
- NPI assigned
- Jan 27, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ihc Health Services Inc
Practice addresses (Care Compare)
11520 S Redwood Rd
South Jordan, UT 84095-7805
Phone (385) 887-7300
2075 N 1200
Layton, UT 84041-1611
Phone (801) 779-6200
2075 University Park Blvd
Layton, UT 84041-1611
Phone (801) 387-6200
3723 W 1200
Riverton, UT 84065-7296
Phone (801) 535-7035
3723 W 12600
Riverton, UT 84065-7295
Phone (801) 285-2482
3723 W 12600
Riverton, UT 84065-7296
3741 W 12600
Riverton, UT 84065-7215
5323 S Woodrow St
Murray, UT 84107-5841
Phone (801) 261-8346
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
- Intermountain Homecare Home Health Salt Lake
- Intermountain Health Riverton Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121031000153 | UT | Practitioner - Physician Assistant | 3173706918 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8289902-1206 | UT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ihc Health Services Inc | Current |
Accepting new patients | |
| Ihc Health Services, Inc. | Current |
Accepting new patients |
Locations
700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555
3723 W 12600 S
Ste 460
Riverton, UT 84065
Phone (801) 285-4650
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA21433 | CA | |
| Physician Assistant | 363A00000X | 8289902-1206 | UT | Yes |
Addresses
Primary practice location
3304 Renner Dr
Fortuna, CA 95540-7102
Mailing address
PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 285-4650
Other providers in Fortuna, CA
- Lori Ann Cutler
- Francis W Cutruzzola
- David Joseph D'Amico
- David J. D'Amico Chiropractic, Inc.
- Britain Kalob Davis
- Imelda De Los Santos
- Danilo Santiago Dela Cruz
- Andrew Marcus Delgado
- Stephanie L Demara
- Dickerson Solution
All providers in Fortuna, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.