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MIKKA MICHELE PENDERGRASS AGACNP
NPI 1649846304
Nurse Practitioner - Acute Care in Salt Lake City, UT

Active since June 02, 2021PECOS EnrolledAccepts Medicare Assignment
92.06/100
CMS Quality Rating
1950 CIRCLE OF HOPE DR, SALT LAKE CITY, UT 84112(801) 581-2436 Get Directions Write a Review

NPPES record last updated: November 11, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 11, 2021, Jun 2, 2021 (2 updates tracked since 2021).

About Mikka Michele Pendergrass Agacnp NPPES

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

MIKKA MICHELE PENDERGRASS AGACNP (NPI 1649846304) is an individual acute care provider in Salt Lake City, Utah, licensed in Utah (86680593102) and active in the NPI registry since June 2021. She is enrolled in Medicare PECOS, is affiliated with University Of Utah Hospitals And Clinics, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1649846304
Entity TypeIndividualFemale
Primary Taxonomy363LA2100X
Provider Legal NameMIKKA MICHELE PENDERGRASSCredential: AGACNP
Location Address1950 CIRCLE OF HOPE DRSalt Lake City, UT 84112-5500
Mailing Address461 S 400 EAmerican Fork, UT 84003-2515 · (801) 901-7688
Phone(801) 581-2436
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateJune 2, 2021
Last NPPES UpdateNovember 11, 20212 updates tracked since enumeration
NPPES CertifiedNovember 11, 2021
✔ NPI 1649846304 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
License✔ Licensed in UT · 86680593102
1950 CIRCLE OF HOPE DR, Salt Lake City, UT 84112
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Molina Healthcare, Select Health.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mikka Michele Pendergrass Agacnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2062817786
PECOS Enrollment IDI20210818003321
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.

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205
This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
41 services41 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
36 services33 patients
Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or G2212
This service refers to extended doctor visits where your healthcare provider spends additional time evaluating and managing your health beyond the primary procedure's required time. This includes each extra 15 minutes spent by the physician on the same day as the primary service.
35 services21 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
20 services20 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
12 services12 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

University Of Utah Hospitals And Clinics

Acute Care Hospitals · Salt Lake City, UT
5/5 CMS rating
OwnershipGovernment - State
CMS Certification Number460009
Location50 North Medical DriveSalt Lake City, UT 84132 · Salt Lake County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84112 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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

92.06/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality85.57
Promoting Interoperability100
Improvement Activities40

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.

BMT DIVISION DEPARTMENT OF UNIVERSITY OF UTAH
Internal Medicine (Hematology & Oncology)
1950 CIRCLE OF HOPE DR
SALT LAKE CITY, UT 84112
Salt Lake County (801) 581-2121
SETH YOUKSTETTER PA-C
Physician Assistant
1950 CIRCLE OF HOPE DR
SALT LAKE CITY, UT 84112
Salt Lake County (801) 585-0100
STEPHANIE BAKER NEERINGS MSN, APRN, FNP-BC
Nurse Practitioner (Family)
1950 CIRCLE OF HOPE DR
SALT LAKE CITY, UT 84112
Salt Lake County (801) 587-7000
STEPHANIE ANNA SANDERS PHARM.D.
Pharmacist
1950 CIRCLE OF HOPE DR, SUITE 2110
SALT LAKE CITY, UT 84112
Salt Lake County (801) 587-4272
MS. ERICA JANE FARR PA-C
Physician Assistant (Medical)
1950 CIRCLE OF HOPE DR, SUITE 2810
SALT LAKE CITY, UT 84112
Salt Lake County (801) 213-5688
KATE BLAKE NP
Nurse Practitioner
1950 CIRCLE OF HOPE DR
SALT LAKE CITY, UT 84112
Salt Lake County (801) 587-7000
THU M TRAN PHARMD
Pharmacist (Oncology)
1950 CIRCLE OF HOPE DR, SUITE 2110, PHARMACY SERVICES
SALT LAKE CITY, UT 84112
Salt Lake County (801) 587-4475
MARTHA JANE GLENN MD
Internal Medicine (Medical Oncology)
1950 CIRCLE OF HOPE DR
SALT LAKE CITY, UT 84112
Salt Lake County (801) 213-3800

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 Mikka Pendergrass's NPI number?

The NPI number for Mikka Pendergrass is 1649846304. It was assigned to this individual provider in the NPPES registry on June 2, 2021.

Where is Mikka Pendergrass located?

Mikka Pendergrass practices at 1950 Circle Of Hope Dr, Salt Lake City, UT 84112. The listed phone number is (801) 581-2436.

What is Mikka Pendergrass's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Is Mikka Pendergrass enrolled in Medicare?

Yes. Mikka Pendergrass is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Mikka Pendergrass accept?

Health plans from Molina Healthcare and Select Health list Mikka Pendergrass 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.

Is Mikka Pendergrass affiliated with any hospitals?

According to CMS data, Mikka Pendergrass is affiliated with University Of Utah Hospitals And Clinics.

When was this NPI record last updated?

The NPPES record for Mikka Pendergrass was last updated on November 11, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.