BRANT WAHLEN FONNESBECK DO
NPI 1033156849
Family Medicine in Logan, UT

Q: What is Brant Fonnesbeck's NPI number?

The NPI number for Brant Fonnesbeck is 1033156849. It was assigned to this individual provider in the NPPES registry on June 1, 2006.

Q: What is Brant Fonnesbeck's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Brant Fonnesbeck was last updated on February 26, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 01, 2006PECOS Enrolled

550 E 1400 N STE K, LOGAN, UT 84341(435) 755-6061 Get Directions Write a Review

NPPES record last updated: February 26, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Brant Wahlen Fonnesbeck Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRANT WAHLEN FONNESBECK DO (NPI 1033156849) is an individual family medicine provider in Logan, Utah, licensed in Utah (5953772-1204) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS and is a graduate of At Still University Of Health Sciences, College Of Osteo Med, Kirksville (2004).

NPPES Registry Identity

NPI1033156849

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameBRANT WAHLEN FONNESBECKCredential: DO

Location Address550 E 1400 N STE KLogan, UT 84341-2450

Mailing Address325 W Logan Hwy, Po Box 328Garden City, UT 84028 · (435) 764-7249

Phone(435) 755-6061

Sole ProprietorNo

Medical School CMSAt Still University Of Health Sciences, College Of Osteo Med, KirksvilleGraduated 2004

Enumeration DateJune 1, 2006

Last NPPES UpdateFebruary 26, 2008

✔ NPI 1033156849 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in UT · 5953772-1204

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

550 E 1400 N STE K, Logan, UT 84341

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, HMSA, Molina Healthcare and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Brant Wahlen Fonnesbeck Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3274558564

PECOS Enrollment IDI20051005001126, I20180911003965

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84341 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$84.41 typical visit price

range $54.34 – $166.03

Typical copayment $21.10 (range $13.58 – $41.50)

Most-billed visit code 99203

Established Patient

$96.35 typical visit price

range $17.23 – $135.20

Typical copayment $24.08 (range $4.30 – $33.80)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

IHC HEALTH SERVICES INC

Internal Medicine (Nephrology)

550 E 1400 N STE K
LOGAN, UT 84341

Cache County (801) 507-2531

MR. GREGG R LUKE R.PH.

Pharmacist

550 E 1400 N STE K
NORTH LOGAN, UT 84341

Cache County (435) 755-8424

KEISA M LYNCH

Nurse Practitioner (Family)

550 E 1400 N STE K
LOGAN, UT 84341

Cache County (435) 755-6061

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brant Fonnesbeck's NPI number?

The NPI number for Brant Fonnesbeck is 1033156849. It was assigned to this individual provider in the NPPES registry on June 1, 2006.

Where is Brant Fonnesbeck located?

Brant Fonnesbeck practices at 550 E 1400 N Ste K, Logan, UT 84341. The listed phone number is (435) 755-6061.

What is Brant Fonnesbeck's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Brant Fonnesbeck enrolled in Medicare?

Yes. Brant Fonnesbeck is registered in the Medicare PECOS enrollment system.

What insurance does Brant Fonnesbeck accept?

Health plans from BridgeSpan Health Company, HMSA, Molina Healthcare, Regence BlueCross BlueShield of Utah and Select Health and 1 other insurer list Brant Fonnesbeck as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Brant Fonnesbeck was last updated on February 26, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.