NPIMap

Individual provider Active NPI

Carina M Jackman, M.D.

  • Anesthesiology Physician
  • Milwaukee, WI
National Provider Identifier
1003170127
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
8831884-1205 Issued in UT
Practice address
5000 W Chambers St
Milwaukee, WI 53210-1650
Phone
(414) 447-2196
NPI assigned
Jul 3, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Anesthesiology Physician 207L00000X 8831884-1205 UT Primary

Addresses

Primary practice location

5000 W Chambers St
Milwaukee, WI 53210-1650

Mailing address

5000 W Chambers St
Milwaukee, WI 53210-1650

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cjackman66748@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160629001689 UT Practitioner - Anesthesiology 4981837093 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Medical College of Wisconsin, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

50 N Medical Dr
Salt Lake City, UT 84132-0100
Phone (801) 585-3229

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
8831884-1205UTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services Anesthesiology CurrentSince May 1, 2016 Accepting new patients
University of Utah Adult Services Current Accepting new patients
Physician Group of Utah Inc CurrentSince Dec 1, 2017 Accepting new patients
University of Utah Adult Services CurrentSince May 1, 2016 Accepting new patients
University of Utah Acuity Care Services CurrentSince May 1, 2016 Accepting new patients
University of Utah Acuity Care Services CurrentSince May 1, 2016 Accepting new patients
Bronson Lakeview Hospital Past Accepting new patients

Locations

30 N 1900 E
#1C412
Slc, UT 84132
Phone (732) 275-2281

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

1950 Circle of Hope Dr
Slc, UT 84112
Phone (801) 585-0100

2530 W 4700 S
Ste B8
Taylorsville, UT 84129
Phone (801) 967-5866

3590 W 9000 S
Ste 240
West Jordan, UT 84088
Phone (801) 505-5370

3580 W 90th S
West Jordan, UT 84088
Phone (801) 263-0810

Interoperability endpoints

  • Direct secure messaging: cjackman66748@direct.med.utah.edu

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1003170127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 W CHAMBERS ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532101650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 W CHAMBERS ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532101650",
            "telephone_number": "414-447-2196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKMAN",
        "first_name": "CARINA",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-03",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "8831884-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cjackman66748@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.