BRANT WAHLEN FONNESBECK (DO) – Family Medicine Physician, NPI 1033156849
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,136 FAMILY PRACTICE in UT
Provider Addresses for BRANT WAHLEN FONNESBECK (DO)
325 W LOGAN HWY
PO BOX 328
GARDEN CITY, UT 84028
Phone: (435) 764-7249
Type: Mailing
550 E 1400 N STE K
LOGAN, UT 843412450
Phone: (435) 755-6061
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 19 Open Payments records for all available years, with a total value of $414.
Total Amount is formed as General ($414) + Research ($0) + Ownership ($0) = $414.
Last reported payment date: 2024-10-18 • Largest payer in this snapshot: Inspire Medical Systems, Inc. ($109).
Total Amount
$414
General + Research + Ownership
Payments
19
Total payment records
General Amount
$414
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-18
Latest reported date
Top Companies
Largest payers in this snapshot
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-09-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20051005001126 | I | Family Practice | UT | TBD |
| I20180911003965 | I | Family Practice | HI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 84028)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | NC | |
| Internal Medicine | UT | |
| Nurse Practitioner | MT | |
| Internal Medicine | UT | |
| D E R M A T O L O G Y | RI | |
| Emergency Medicine | UT | |
| Internal Medicine | MA | |
| Physician Assistant | CA | |
| Physician Assistant | UT | |
| Family Practice | UT |
Reviews
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