Jordan Tab Frei, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

12319995-1205 Issued in UT

Practice address

267 E Traversepoint Dr
Draper, UT 84020-5679

Phone

(801) 553-8300

Fax

(801) 553-8301

NPI assigned

Apr 4, 2018

Last updated

Aug 16, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• South Summit Pediatrics. LLC

  • Legal Medicine
  • Draper, UT
  • NPI 1760490122
  NPD (past)
• Utah Imaging Associates Inc

  • Diagnostic Radiology Physician
  • Farmington, UT
  • NPI 1629076229
  NPD (past)

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

{
    "created_epoch": "1522800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629072000000",
    "number": "1093211369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "267 E TRAVERSEPOINT DR",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840205679",
            "telephone_number": "801-553-8300",
            "fax_number": "801-553-8301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 E TRAVERSEPOINT DR",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840205679",
            "telephone_number": "801-553-8300",
            "fax_number": "801-553-8301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREI",
        "first_name": "JORDAN",
        "middle_name": "TAB",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-04",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "12319995-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan O'Dell Frandsen, OD
• Kate Frandsen
• Scott G Frazier, CMHC
• Elizabeth Frederick
• Brian Colton Free
• Andrew Frost, DC
• Richard H Fryer, MD
• Kamila Fuentes
• Mary-Faith Fuller, CPNP
• Benjamin Fung, PT, DPT, MBA

• Pediatrics Physician in Draper, UT
• Providers in Draper, UT by specialty
• Pediatrics Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.