DANIEL JR. FONG (PA-C) – Physician Assistant, NPI 1720450646
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,971 PHYSICIAN ASSISTANT in UT
Provider Addresses for DANIEL JR. FONG (PA-C)
10 W BROADWAY FL 7
SALT LAKE CITY, UT 841012060
Phone: (866) 849-0692
Type: Location
707 SHERIDAN AVE
CODY, WY 824143409
Phone:
Type: Mailing
424 YELLOWSTONE AVE STE 120
CODY, WY 824149311
Phone: (307) 578-2903
Type: Location
777 AVENUE H
POWELL, WY 824352260
Phone: (307) 754-2267
Type: Mailing
424 Yellowstone Ave Ste 120
Cody, WY 824149311
Phone: (307) 578-2903
Type: Location
777 Avenue H
Powell, WY 824352260
Phone: (307) 754-2267
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: 2019-05-02
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 |
|---|---|---|---|---|
| I20160205000900 | I | Physician Assistant | CO | TBD |
| I20190502000136 | 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 84101)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | WY | |
| Emergency Medicine | WY | |
| Family Practice | WY | |
| Nurse Practitioner | WY | |
| Physician Assistant | WY | |
| Orthopedic Surgery | WY | |
| Diagnostic Radiology | OR | |
| Emergency Medicine | WY | |
| - | WY | |
| Certified Registered Nurse Anesthetist (Crna) | WY |
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