SAMUEL R EVERETT PA-C
NPI 1104224815
Clinical Nurse Specialist - Psychiatric/Mental Health in Murray, UT

Active since December 11, 2014PECOS Enrolled
154 E MYRTLE AVE STE 204, MURRAY, UT 84107(801) 369-8989(801) 704-9741 Get Directions Write a Review

NPPES record last updated: October 12, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Oct 12, 2023, Sep 6, 2023, Sep 18, 2020 and 1 more (4 updates tracked since 2019).

About Samuel R Everett Pa-c NPPES

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

SAMUEL R EVERETT PA-C (NPI 1104224815) is an individual psychiatric/mental health provider in Murray, Utah, licensed in Utah (9492493-1206) and active in the NPI registry since December 2014. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104224815
Entity TypeIndividualMale
Primary Taxonomy364SP0808X
Provider Legal NameSAMUEL R EVERETTCredential: PA-C
Location Address154 E MYRTLE AVE STE 204Murray, UT 84107-4850
Mailing Address154 E Myrtle Ave Ste 204Murray, UT 84107-4850 · (801) 369-8989 · Fax (801) 704-9741
Fax(801) 704-9741
Sole ProprietorNo
Enumeration DateDecember 11, 2014
Last NPPES UpdateOctober 12, 20234 updates tracked since enumeration
NPPES CertifiedOctober 12, 2023
NPI 1104224815 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyClinical Nurse Specialist · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code364SP0808X
License Licensed in UT · 9492493-1206
Also ListedPhysician AssistantTaxonomy 363A00000X · License 9492493-1206 (UT)
154 E MYRTLE AVE STE 204, Murray, UT 84107

Other Names 1

Former Name (1)Mallory Danielson Pa-c

Accepted 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)

Samuel R Everett Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 84107 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
$125.70 typical visit price
range $54.34 – $166.03
Typical copayment $31.42 (range $13.58 – $41.50)
Most-billed visit code 99204
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.

MIPS Quality Measures

The following performance measures were reported under the Merit-Based Incentive Payment System (MIPS) and Qualified Clinical Data Registry (QCDR) quality measures program.

Quality Measure Performance Number of Patients
Adult Major Depressive Disorder (MDD): Suicide Risk Assessment 0% 172
Documentation of Current Medications in the Medical Record 32% 1194
Preventive Care and Screening: Screening for Depression and Follow-Up Plan 47% 102
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 2% 335
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 2% 335

Other Providers at the Same Location NPPES 11

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

Psychiatry & Neurology (Psychiatry)
154 E MYRTLE AVE STE 204
MURRAY, UT 84107
Physician Assistant
154 E MYRTLE AVE STE 204
MURRAY, UT 84107
Social Worker (Clinical)
154 E MYRTLE AVE STE 204
MURRAY, UT 84107
Psychologist (Clinical)
154 E MYRTLE AVE STE 204
MURRAY, UT 84107
Nurse Practitioner (Psychiatric/Mental Health)
154 E MYRTLE AVE STE 204
MURRAY, UT 84107
Social Worker (Clinical)
154 E MYRTLE AVE STE 204
MURRAY, UT 84107
Social Worker (Clinical)
154 E MYRTLE AVE STE 204
SALT LAKE CITY, UT 84107
Social Worker (Clinical)
154 E MYRTLE AVE STE 204
MURRAY, UT 84107

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1104224815, enumerated as an "individual" on December 11, 2014.

The provider is located at 154 E MYRTLE AVE STE 204 MURRAY, UT 84107 and the phone number is (801) 369-8989.

Clinical Nurse Specialist with taxonomy code 364SP0808X and a focus in Psychiatric/Mental Health.

The provider might be accepting Accepts: CareSource and Molina Healthcare. Please consult your insurance carrier or call the provider to verify.