Individual provider Active NPI

Jon C Hansen, PA-C

  • Surgical Physician Assistant
  • Draper, UT
National Provider Identifier
1629435748
Registry record updated May 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
14260704-1206 Issued in UT
Practice address
96 E Kimballs LN Ste 207
Draper, UT 84020-5025
Phone
(801) 576-2300
Fax
(801) 576-2399
NPI assigned
Jan 20, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 14260704-1206 UT Primary

Addresses

Primary practice location

96 E Kimballs LN Ste 207
Draper, UT 84020-5025

Mailing address

PO Box 100253
Atlanta, GA 30384-0253

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
I20260522000935 UT Practitioner - Physician Assistant 0840595120

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountainstar Specialty Services LLCGroup PAC ID 4688767551, 30 clinicians

Practice addresses (Care Compare)

96 E Kimballs LN
Suite 207
Draper, UT 84020-5021
Phone (801) 568-5972

Hospital & facility affiliations

  • Lone Peak Hospital Hospital, Draper, UT, CCN 460060

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14260704-1206UTMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mountainstar Specialty Services LLC Past Accepting new patients

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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": "1453248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778112000000",
    "number": "1629435748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100253",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303840253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 E KIMBALLS LN STE 207",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840205025",
            "telephone_number": "801-576-2300",
            "fax_number": "801-576-2399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSEN",
        "first_name": "JON",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-20",
        "last_updated": "2026-05-07",
        "certification_date": "2026-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "UT",
            "license": "14260704-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Draper, UT

Sources for this page

Verify at the official NPI Registry.