KELLY R AVERETT (PA-C) – Physician Assistant, NPI 1306198924
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
1,971 PHYSICIAN ASSISTANT in UT
Provider Addresses for KELLY R AVERETT (PA-C)
470 E 3900 S
STE 200
SALT LAKE CITY, UT 841071880
Phone: (801) 262-9782
Fax: (801) 262-8632
Type: Mailing
1050 E SOUTH TEMPLE
SALT LAKE CITY, UT 841021507
Phone: (801) 350-4111
Type: Location
PO BOX 100253
ATLANTA, GA 303840253
Phone:
Type: Mailing
1200 E 3900 S UNIT G175
SALT LAKE CITY, UT 841241300
Phone: (801) 268-7405
Fax: (801) 268-7435
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $26.
Total Amount is formed as General ($26) + Research ($0) + Ownership ($0) = $26.
Last reported payment date: 2024-11-12 • Largest payer in this snapshot: Hologic Sales and Service, LLC ($26).
Total Amount
$26
General + Research + Ownership
Payments
1
Total payment records
General Amount
$26
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-12
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Hologic Sales and Service, LLC | $26 |
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: 2012-12-13
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 |
|---|---|---|---|---|
| I20121213000042 | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 46 | 41 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 37 | 37 | $0 |
| 81002 | Urinalysis, manual test | 13 | 13 | $0 |
Insurance plans in this area (ZIP 84107)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Orthopedic Surgery | UT | |
| Orthopedic Surgery | NV | |
| Physician Assistant | UT | |
| - | GA | |
| Orthopedic Surgery | GA | |
| Orthopedic Surgery | TX | |
| General Surgery | GA | |
| Orthopedic Surgery | UT | |
| General Surgery | UT | |
| Physician Assistant | UT |
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