NPIMap

Individual provider Active NPI

Joseph Richard Jacob, M.D.

  • Otolaryngology Physician
  • St George, UT
National Provider Identifier
1134446891
Registry record updated Apr 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
8138585-1205 Issued in UT
Practice address
1490 E Foremaster Dr
Ste 350
Saint George, UT 84790-4488
Phone
(435) 628-3337
Fax
(435) 628-3375
NPI assigned
Apr 21, 2010
Last updated
Apr 27, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X UT
Otolaryngology Physician 207Y00000X 8138585-1205 UT Primary

Addresses

Primary practice location

1490 E Foremaster Dr
Ste 350
Saint George, UT 84790-4488

Mailing address

1490 E Foremaster Dr
Ste 350
Saint George, UT 84790-4488
Phone (435) 628-3337

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
I20150716000778 UT Practitioner - Otolaryngology 5890927701 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Albert Einstein College of Medicine of Yeshiva University, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Utah Ear Nose and Throat LLCGroup PAC ID 4082772777, 15 clinicians

Practice addresses (Care Compare)

617 E Riverside Dr
Suite 201
St George, UT 84790-8721
Phone (435) 628-3334

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
76.42 of 100Reported as group
Quality
65.48
Promoting interoperability
95
Improvement activities
40
Cost
60.1

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision18
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Utah Ear Nose & Throat LLC Otolaryngology CurrentSince Aug 1, 2015 Accepting new patients
Elite Anesthesia Associates Past Accepting new patients

Locations

1490 E Foremaster Dr
Ste 350
St George, UT 84790
Phone (435) 251-5980

617 E Riverside Dr
Ste 201
St George, UT 84790
Phone (435) 628-3334

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 4

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": "1271808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430092800000",
    "number": "1134446891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1490 E FOREMASTER DR",
            "address_2": "STE 350",
            "city": "SAINT GEORGE",
            "state": "UT",
            "postal_code": "847904488",
            "telephone_number": "435-628-3337",
            "fax_number": "435-628-3375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 E FOREMASTER DR",
            "address_2": "STE 350",
            "city": "SAINT GEORGE",
            "state": "UT",
            "postal_code": "847904488",
            "telephone_number": "435-628-3337",
            "fax_number": "435-628-3375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "JOSEPH",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-21",
        "last_updated": "2015-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "UT",
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "UT",
            "license": "8138585-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St George, UT

Sources for this page

Verify at the official NPI Registry.