Active NPI
Jon Lawson Landeen, MD
- Obstetrics & Gynecology Physician
- Moab, UT
National Provider Identifier
1205890928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 1522641205
- Practice address
- 719 W 400 N
Moab, UT 84532-2239 - Phone
- (435) 259-7191
- NPI assigned
- Apr 12, 2006
- Last updated
- Apr 29, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 1522641205 | UT | Primary |
Addresses
Primary practice location
719 W 400 N
Moab, UT 84532-2239
Mailing address
400 E 10TH St
Waconia, MN 55387-4552
Phone (952) 442-9770
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04295 | Medicaid | UT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1522641205 | UT | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jon W Ahlstrom MD PC | Obstetrics & Gynecology | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Obstetrics & Gynecology Physician
- North Logan, UT
- NPI 1679847784
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209427200000",
"number": "1205890928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 E 10TH ST",
"city": "WACONIA",
"state": "MN",
"postal_code": "553874552",
"telephone_number": "952-442-9770",
"fax_number": "952-442-3630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "719 W 400 N",
"city": "MOAB",
"state": "UT",
"postal_code": "845322239",
"telephone_number": "435-259-7191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANDEEN",
"first_name": "JON",
"middle_name": "LAWSON",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-12",
"last_updated": "2008-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "UT",
"license": "1522641205",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04295",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moab, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.