NPIMap

Individual provider Active NPI

Jeffrey D Jackson, MD

  • Orthopaedic Surgery Physician
  • Salt Lake City, UT
National Provider Identifier
1033123179
Registry record updated Jan 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
48648 Issued in MN
Practice address
1160 E 3900 S Ste 5000
Salt Lake City, UT 84124-1275
Phone
(801) 261-7479
Fax
(801) 261-7429
NPI assigned
Jul 27, 2006
Last updated
Jan 27, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 48648 MN Primary

Addresses

Primary practice location

1160 E 3900 S Ste 5000
Salt Lake City, UT 84124-1275

Mailing address

PO Box 100253
Atlanta, GA 30384-0253

Other identifiers 1

IdentifierTypeStateIssuer
797903000MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jjackson4840@epicmtn.hcadirect.net

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
I20110816000871 UT Practitioner - Orthopedic Surgery 3274536784 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Utah School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountainstar Specialty Services LLCGroup PAC ID 4688767551, 30 clinicians

Practice addresses (Care Compare)

8846 S Redwood Rd
Suite 121
West Jordan, UT 84088-9366
Phone (801) 569-1999

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.68 of 100Reported as individual
Quality
74.83
Promoting interoperability
100
Improvement activities
40
Cost
57.44

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Knee replacement37
Lower limb (leg) arthroscopy (minimally invasive joint repair)18
Upper limb (arm) arthroscopy (minimally invasive joint repair)36

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mountainstar Specialty Services LLC CurrentSince Dec 1, 2019 Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

1160 E 3900 S
Ste 4050
Salt Lake Cty, UT 84124
Phone (801) 262-8486

1160 E 3900 S
Ste 5000
Slc, UT 84124
Phone (801) 261-7479

8846 S Redwood Rd
Ste 121
West Jordan, UT 84088
Phone (801) 545-8480

Networks

  • UT PPO D-SNP
  • UT PPO

Interoperability endpoints

  • Direct secure messaging: jjackson4840@epicmtn.hcadirect.net

Organizations & group practices 2

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

Hospital & facility affiliations 7

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": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643241600000",
    "number": "1033123179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100253",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303840253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 E 3900 S STE 5000",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241275",
            "telephone_number": "801-261-7479",
            "fax_number": "801-261-7429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JEFFREY",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2022-01-27",
        "certification_date": "2020-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MN",
            "license": "48648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "797903000",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jjackson4840@epicmtn.hcadirect.net",
            "affiliation": "N",
            "address_1": "1160 E 3900 S Ste 5000",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841241275",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.