MRS. CASSIE K BROADHEAD (PA-C) – Physician Assistant, NPI 1083087944
Physician Assistant
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MRS. CASSIE K BROADHEAD (PA-C)
1055 N 500 W
ATTN: CREDENTIALING
PROVO, UT 846043305
Phone: (801) 354-8225
Fax: (801) 418-0941
Type: Mailing
97 PROFESSIONAL WAY
STE 2
PAYSON, UT 846511614
Phone: (801) 465-4896
Fax: (801) 465-4107
Type: Location
97 Professional Way
Ste 2
Payson, UT 846511614
Phone: (801) 465-4896
Fax: (801) 465-4107
Type: Location
PO BOX 27128
SALT LAKE CITY, UT 841270128
Phone:
Fax: (801) 418-0941
Type: Mailing
1034 N 500 W
PROVO, UT 846043380
Phone: (801) 357-3367
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2016-02-11
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 |
|---|---|---|---|---|
| I20151207000869 | I | Physician Assistant | UT | TBD |
| I20160211000873 | I | Physician Assistant | WY | 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 84604)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | UT | |
| Physician Assistant | TX | |
| Nurse Practitioner | UT | |
| General Surgery | UT | |
| Nurse Practitioner | UT | |
| Diagnostic Radiology | MT | |
| Nurse Practitioner, Family Practice | UT | |
| - | UT | |
| Nurse Practitioner | UT | |
| Physician Assistant | UT |
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