Individual provider Active NPI

Jacob Basilius, MD

  • Urology Physician
  • Orange, CA
National Provider Identifier
1043741911
Registry record updated Apr 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
10955731-1205 Issued in UT
Practice address
101 The City Dr S
Orange, CA 92868-3201
Phone
(714) 880-7812
NPI assigned
Mar 23, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 10955731-1205 UT Primary

Addresses

Primary practice location

101 The City Dr S
Orange, CA 92868-3201

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 357-3242

Other practice location 1

395 W Cougar Blvd Ste 704
Provo, UT 84604-3333
Phone (801) 357-3242

Other practice location 2

30 N 1900 E
Salt Lake City, UT 84132-0002
Phone (801) 581-7304

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRReguest_Service Other Bluemark LLC / Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, UT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220624000379 CA Practitioner - Urology 4284988940 Reassigns benefits to 1 organization
I20230525000845 UT Practitioner - Urology 4284988940 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Utah School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

395 W Bulldog Blvd
Suite 704
Provo, UT 84604-3333
Phone (801) 357-3242

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection21

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10955731-1205UTMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc Current Accepting new patients
Uci Department of Urology Urology CurrentSince Jul 1, 2022 Accepting new patients
Ihc Health Services Inc CurrentSince Apr 22, 2023 Accepting new patients
Ihc Health Services, Inc. CurrentSince Apr 22, 2023 Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

2801 Atlantic Ave
Long Beach, CA 90806
Phone (310) 933-2000

101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054

98 N 1100 E
Ste 203
American Fork, UT 84003
Phone (801) 357-3242

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

380 E 1500 S
Ste 202
Heber City, UT 84032
Phone (435) 657-4600

395 W Cougar Blvd
Ste 704
Provo, UT 84604
Phone (801) 357-3242

819 E Market Place Dr
Spanish Fork, UT 84660
Phone (385) 344-6600

1300 SE Cardinal Ct
Ste 190
Vancouver, WA 98683
Phone (360) 448-4479

Interoperability endpoints

  • Direct secure messaging: jbasilius747899@direct.memorialcare.org

Organizations & group practices 5

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 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": "1490227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776384000000",
    "number": "1043741911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-357-3242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "714-880-7812"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "395 W Cougar Blvd Ste 704",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846043333",
            "country_code": "US",
            "telephone_number": "801-357-3242",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "30 N 1900 E",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841320002",
            "country_code": "US",
            "telephone_number": "801-581-7304",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BASILIUS",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-23",
        "last_updated": "2026-04-17",
        "certification_date": "2026-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "UT",
            "license": "10955731-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRReguest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.