STACI JANAE BRANDENBURG PA-C
NPI 1487279626
Physician Assistant - Medical in West Valley City, UT

Q: What is Staci Brandenburg's NPI number?

The NPI number for Staci Brandenburg is 1487279626. It was assigned to this individual provider in the NPPES registry on June 13, 2020.

Q: What is Staci Brandenburg's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Staci Brandenburg was last updated on October 14, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months 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 13, 2020PECOS Enrolled

2965 W 3500 S, WEST VALLEY CITY, UT 84119(801) 965-3419 Get Directions Write a Review

NPPES record last updated: October 14, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Oct 4, 2023, Jan 6, 2022, Jun 13, 2020 (3 updates tracked since 2020).

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About Staci Janae Brandenburg Pa-c NPPES

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

STACI JANAE BRANDENBURG PA-C (NPI 1487279626) is an individual medical provider in West Valley City, Utah, licensed in Utah (12602904-8906) and active in the NPI registry since June 2020. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1487279626

Entity TypeIndividualFemale

Primary Taxonomy363AM0700X

Provider Legal NameSTACI JANAE BRANDENBURGCredential: PA-C

Location Address2965 W 3500 SWest Valley City, UT 84119-3602

Mailing Address2965 W 3500 SWest Valley City, UT 84119-3602 · (801) 965-3600

Phone(801) 965-3419

Sole ProprietorNo

Enumeration DateJune 13, 2020

Last NPPES UpdateOctober 14, 20243 updates tracked since enumeration

NPPES CertifiedOctober 14, 2024

✔ NPI 1487279626 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in UT · 12602904-8906

Also ListedPhysician AssistantTaxonomy 363A00000X · License 12602904-8906 (UT)

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

2965 W 3500 S, West Valley City, UT 84119

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Staci Janae Brandenburg 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.

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.

DR. CASEY JOSEPH HENICH MD

Family Medicine