Individual provider Active NPI

Jordan Gaudio, MD

  • Pediatrics Physician
  • Provo, UT
National Provider Identifier
1063946325
Registry record updated Dec 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
13384855-1205 Issued in UT
Practice address
1034 N 500 W
Provo, UT 84604-3380
Phone
(801) 357-1700
NPI assigned
Apr 13, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 13384855-1205 UT Primary
Pediatric Critical Care Medicine Physician 2080P0203X 13384855-1205 UT

Addresses

Primary practice location

1034 N 500 W
Provo, UT 84604-3380

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128

Other practice location 1

111 Michigan Ave NW
Washington, DC 20010-2916
Phone (202) 476-3670

Other names 1

  • Jordan Derck Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jgaudio638724@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: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230929002484 UT Practitioner - Pediatric Medicine 5395199939 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13384855-1205UTMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Pediatric Acuity Care Pediatrics Current Accepting new patients
Ihc Health Services, Inc. CurrentSince Jan 2, 2024 Accepting new patients
Ihc Health Services Inc CurrentSince Jan 2, 2024 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
University of Utah Pediatric Acuity Care CurrentSince Aug 16, 2023 Accepting new patients
Wasatch Pediatrics, Inc Pediatrics Past Accepting new patients

Locations

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

1034 N 500 W
Provo, UT 84604
Phone (801) 362-4119

100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109

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

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1492041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764547200000",
    "number": "1063946325",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 N 500 W",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043380",
            "telephone_number": "801-357-1700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Michigan Ave NW",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200102916",
            "country_code": "US",
            "telephone_number": "202-476-3670",
            "fax_number": "202-476-4741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAUDIO",
        "first_name": "JORDAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-13",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "13384855-1205",
            "primary": true
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "UT",
            "license": "13384855-1205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jgaudio638724@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": [
        {
            "first_name": "JORDAN",
            "last_name": "DERCK",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.