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BREANNA BRADLEY BLACK PA-C
NPI 1346972502
Physician Assistant in Provo, UT

Active since June 27, 2022PECOS Enrolled
1055 N 500 W BLDG A, PROVO, UT 84604(801) 812-5033(801) 418-0941 Get Directions Write a Review

NPPES record last updated: October 3, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Breanna Bradley Black Pa-c NPPES

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

BREANNA BRADLEY BLACK PA-C (NPI 1346972502) is an individual physician assistant in Provo, Utah, licensed in Utah (13603008-1206) and active in the NPI registry since June 2022. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1346972502
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameBREANNA BRADLEY BLACKCredential: PA-C
Location Address1055 N 500 W BLDG AProvo, UT 84604-3305
Mailing Address1055 N 500 W, Attn CredentialingProvo, UT 84604-3305 · (801) 354-8225 · Fax (801) 418-0941
Phone(801) 812-5033
Fax(801) 418-0941
Sole ProprietorNo
Enumeration DateJune 27, 2022
Last NPPES UpdateOctober 3, 2023
NPPES CertifiedOctober 3, 2023
✔ NPI 1346972502 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in UT · 13603008-1206
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1055 N 500 W BLDG A, Provo, UT 84604
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Molina Healthcare, Regence BlueCross BlueShield of Utah 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)

Breanna Bradley Black 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 84604 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
$68.01 typical visit price
range $17.23 – $135.20
Typical copayment $17.00 (range $4.30 – $33.80)
Most-billed visit code 99213
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 20

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

BEVERLY LARAINE WILLIAMS
Social Worker (Clinical)
1055 N 500 W BLDG A
PROVO, UT 84604
Utah County (801) 354-8225
MARIA RUTH HOEGH APRN
Nurse Practitioner (Family)
1055 N 500 W BLDG A
PROVO, UT 84604
Utah County (801) 812-5033
ELIZABETH ANN LARSEN APRN
Nurse Practitioner (Family)
1055 N 500 W BLDG A
PROVO, UT 84604
Utah County (801) 812-5033
AMY LYNN DALTON
Nurse Practitioner
1055 N 500 W BLDG A
PROVO, UT 84604
Utah County (801) 812-5033
CAITLIN BROOK MALLORY FNP
Nurse Practitioner (Family)
1055 N 500 W BLDG A
PROVO, UT 84604
Utah County (801) 812-5033
JASON ALLEN PA
Physician Assistant
1055 N 500 W BLDG A
PROVO, UT 84604
Utah County (801) 812-5033
AUBREE MCKELL EARNEST
Nurse Practitioner (Family)
1055 N 500 W BLDG A
PROVO, UT 84604
Utah County (801) 812-5033
LEAH TOSHINA YOUNG PA-S
Physician Assistant
1055 N 500 W BLDG A
PROVO, UT 84604
Utah County (801) 812-5033

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 Breanna Black's NPI number?

The NPI number for Breanna Black is 1346972502. It was assigned to this individual provider in the NPPES registry on June 27, 2022.

Where is Breanna Black located?

Breanna Black practices at 1055 N 500 W Bldg A, Provo, UT 84604. The listed phone number is (801) 812-5033.

What is Breanna Black's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Breanna Black enrolled in Medicare?

Yes. Breanna Black is registered in the Medicare PECOS enrollment system.

What insurance does Breanna Black accept?

Health plans from BridgeSpan Health Company, Molina Healthcare, Regence BlueCross BlueShield of Utah, Select Health and University of Utah Health Plans list Breanna Black 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 Breanna Black was last updated on October 3, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.