Active NPI
Heather A Jackson, M.D.
- Family Medicine Physician
- Salt Lake City, UT
National Provider Identifier
1023237088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 7127197-1205
- Practice address
- 2295 Foothill Dr
Salt Lake City, UT 84109-4000 - Phone
- (801) 486-3021
- Fax
- (801) 485-6339
- NPI assigned
- Apr 25, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 7127197-1205 | UT | Primary |
Addresses
Primary practice location
2295 Foothill Dr
Salt Lake City, UT 84109-4000
Mailing address
2295 Foothill Dr
Salt Lake City, UT 84109-4000
Phone (801) 486-3021
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 10, 2025 through Mar 10, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7127197-1205 | UT | MD | Family Medicine Physician |
Interoperability endpoints
- https://epicproxy.et4001.epichosted.com/APIProxyPRD/FFC/api/FHIR/R4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335312000000",
"number": "1023237088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2295 FOOTHILL DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841094000",
"telephone_number": "801-486-3021",
"fax_number": "801-485-6339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2295 FOOTHILL DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841094000",
"telephone_number": "801-486-3021",
"fax_number": "801-485-6339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "HEATHER",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-25",
"last_updated": "2012-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "UT",
"license": "7127197-1205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.