Active NPI
Shaun Mickelsen, PA-C
- Medical Physician Assistant
- Layton, UT
National Provider Identifier
1871945618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 363AM0700X
- Practice address
- 2121 N 1700 W
Layton, UT 84041-8803 - Phone
- (801) 773-4840
- NPI assigned
- Jul 5, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 363AM0700X | UT | Primary |
Addresses
Primary practice location
2121 N 1700 W
Layton, UT 84041-8803
Mailing address
PO Box 337
Layton, UT 84041-0337
Phone (801) 773-4840
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1900 N State St
Provo, UT 84604-1305
Phone (801) 373-2001
Hospital & facility affiliations
- Intermountain Health Utah Valley Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 363AM0700X | UT | MD | Medical Physician Assistant |
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.
-
- Family Medicine Physician
- Provo, UT
- NPI 1205023314
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Provo, UT
- NPI 1114025491
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475712000000",
"number": "1871945618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 337",
"city": "LAYTON",
"state": "UT",
"postal_code": "840410337",
"telephone_number": "801-773-4840",
"fax_number": "801-525-8151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 N 1700 W",
"city": "LAYTON",
"state": "UT",
"postal_code": "840418803",
"telephone_number": "801-773-4840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKELSEN",
"first_name": "SHAUN",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-07-05",
"last_updated": "2016-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "UT",
"license": "363AM0700X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Layton, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.