NPIMap

Individual provider Active NPI

Daniel Fong Jr., PA-C

  • Physician Assistant
  • Salt Lake City, UT
National Provider Identifier
1720450646
Registry record updated Feb 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
10 W Broadway FL 7
Salt Lake City, UT 84101-2060
Phone
(866) 849-0692
NPI assigned
Oct 30, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X WY Primary
Physician Assistant 363A00000X PA.0004438 CO
Physician Assistant 363A00000X 14268608-1206 UT
Surgical Physician Assistant 363AS0400X PA.0004438 CO

Addresses

Primary practice location

10 W Broadway FL 7
Salt Lake City, UT 84101-2060

Mailing address

777 Avenue H
Powell, WY 82435-2260
Phone (307) 754-2267

Other practice location 1

424 Yellowstone Ave Ste 120
Cody, WY 82414-9311
Phone (307) 578-2903

Other practice location 2

777 Avenue H
Powell, WY 82435-2260
Phone (307) 754-2267

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, WY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160205000900 CO Practitioner - Physician Assistant 0446554885 Reassigns benefits to 2 organizations
I20190502000136 WY Practitioner - Physician Assistant 0446554885 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

777 Ave H
Powell, WY 82435

Hospital & facility affiliations

  • Powell Valley Hospital Hospital, Powell, WY, CCN 531310
  • Cody Regional Health Hospital, Cody, WY, CCN 531312
  • Billings Clinic Hospital Hospital, Billings, MT, CCN 270004

Merit-based Incentive Payment System (MIPS)

Final score
82.54 of 100Reported as group
Quality
71.68
Promoting interoperability
100
Improvement activities
40
Cost
70.14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14268608-1206UTMDPhysician Assistant
PA.0004438COMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
West Park Hospital District CurrentSince Mar 31, 2019 Accepting new patients
Powell Valley Health Care Inc CurrentSince Apr 1, 2022 Accepting new patients
Powell Valley Healthcare Inc CurrentSince Apr 1, 2022 Accepting new patients

Locations

707 Sheridan Ave
Cody, WY 82414
Phone (307) 527-7561

424 Yellowstone Ave
Ste 120
Cody, WY 82414
Phone (307) 578-2903

450 Mountain View St
Powell, WY 82435
Phone (307) 754-2267

777 Avenue H
Powell, WY 82435
Phone (307) 754-1175

450 Mountain View St
Unit B
Powell, WY 82435
Phone (307) 754-1202

Interoperability endpoints

  • Direct secure messaging: daniel.fong@powellvalleyhealthcare.cernerdirect.com

Organizations & group practices 6

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 11

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": "1446163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770163200000",
    "number": "1720450646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 AVENUE H",
            "city": "POWELL",
            "state": "WY",
            "postal_code": "824352260",
            "telephone_number": "307-754-2267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 W BROADWAY FL 7",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841012060",
            "telephone_number": "866-849-0692"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "424 Yellowstone Ave Ste 120",
            "address_purpose": "LOCATION",
            "city": "Cody",
            "state": "WY",
            "postal_code": "824149311",
            "country_code": "US",
            "telephone_number": "307-578-2903",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "777 Avenue H",
            "address_purpose": "LOCATION",
            "city": "Powell",
            "state": "WY",
            "postal_code": "824352260",
            "country_code": "US",
            "telephone_number": "307-754-2267",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONG",
        "first_name": "DANIEL",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-30",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WY",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0004438",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "14268608-1206",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "PA.0004438",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.