BRANDON SHAWN MICKELSON (PA-C) – Physician Assistant, NPI 1790544534
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,972 PHYSICIAN ASSISTANT in UT
Provider Addresses for BRANDON SHAWN MICKELSON (PA-C)
280 S MAIN ST
BOUNTIFUL, UT 840106236
Phone: (801) 505-0821
Type: Mailing
11760 S 700 E STE 112
DRAPER, UT 840206605
Phone: (801) 882-9995
Fax: (801) 882-9994
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 12 Open Payments records for all available years, with a total value of $448.
Total Amount is formed as General ($448) + Research ($0) + Ownership ($0) = $448.
Last reported payment date: 2024-10-15 • Largest payer in this snapshot: PFIZER INC. ($125).
Total Amount
$448
General + Research + Ownership
Payments
12
Total payment records
General Amount
$448
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-15
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: 2024-05-23
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 |
|---|---|---|---|---|
| I20240523000425 | 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 84010)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | CA | |
| Physician Assistant | UT | |
| Physician Assistant | UT | |
| Physician Assistant | UT |
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