SAMUEL R EVERETT (PA-C) – Psychiatric/Mental Health Clinical Nurse Specialist, NPI 1104224815
Psychiatric/Mental Health Clinical Nurse Specialist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SAMUEL R EVERETT (PA-C)
154 E MYRTLE AVE STE 204
MURRAY, UT 841074850
Phone: (801) 369-8989
Fax: (801) 704-9741
Type: Location
672 W 400 S STE 201
SPRINGVILLE, UT 846633170
Phone: (801) 369-8989
Fax: (801) 704-9741
Type: Mailing
710 E 200 S Apt 3B
Salt Lake City, UT 841022253
Phone: (385) 376-3739
Fax: (385) 360-9959
Type: Location
140 W 2100 S Ste 110
Salt Lake City, UT 841151855
Phone: (385) 376-3739
Fax: (385) 360-3739
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 60 Open Payments records for all available years, with a total value of $1,506.
Total Amount is formed as General ($1,506) + Research ($0) + Ownership ($0) = $1,506.
Last reported payment date: 2024-06-19 • Largest payer in this snapshot: ABBVIE INC. ($455).
Total Amount
$1,506
General + Research + Ownership
Payments
60
Total payment records
General Amount
$1,506
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-06-19
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: 2016-01-18
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20160118000073 | I | Physician Assistant | UT | 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 84107)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | UT | |
| Nurse Practitioner | DE | |
| Physician Assistant | MI | |
| Clinical Social Worker | UT | |
| Physician Assistant | UT | |
| Nurse Practitioner | UT | |
| P S Y C H I A T R Y | UT | |
| Clinical Social Worker | CO | |
| Clinical Social Worker | UT | |
| Physician Assistant | UT |
Reviews
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