Jon Leroy Pertab, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

7759498-2501 Issued in UT

Practice address

5171 South Cottonwood St Suite 810
Neurosciences Institute,
Murray, UT 84107

Phone

(801) 507-9800

Fax

(801) 507-9800

NPI assigned

Nov 22, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Sandy, UT
  • NPI 1942325154

  UT

  Medicare reassignment Care Compare group NPD
• Center for Human Potential Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Salt Lake City, UT
  • NPI 1548239940

  UT

  Medicare reassignment NPD
• Ihc Health Services Inc

  • Preventive Medicine/Occupational Environmental Medicine Physician
  • Park City, UT
  • NPI 1437692324
  NPD
• Ihc Health Services, Inc.

  • Psychiatry Physician
  • St George, UT
  • NPI 1023843844
  NPD
• Center for Human Potential

  • Community/Behavioral Health Agency
  • Salt Lake City, UT
  • NPI 1366679441
  NPD (past)

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

{
    "created_epoch": "1290384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368144000000",
    "number": "1215239348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5171 SOUTH COTTONWOOD ST SUITE 810",
            "address_2": "NEUROSCIENCES INSTITUTE,",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "84107",
            "telephone_number": "801-507-9800",
            "fax_number": "801-507-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5171 SOUTH COTTONWOOD ST SUITE 810",
            "address_2": "NEUROSCIENCES INSTITUTE,",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "84107",
            "telephone_number": "801-507-9800",
            "fax_number": "801-507-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERTAB",
        "first_name": "JON",
        "middle_name": "LEROY",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-22",
        "last_updated": "2013-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "UT",
            "license": "7759498-2501",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "UT",
            "license": "7759498-2501",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "UT",
            "license": "7759498-2501",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "UT",
            "license": "7759498-2501",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Perfetto Clinical Contracting, Inc
• Tanner Lee Perkes, RN
• Tara Ann Permenter
• Jessica Perri
• Lucas Randall Perry
• Kase Perterson
• Peter G. Larcom MD PC
• Peter V Sundwall MD Pca
• Laura Palmer Peters, RN
• Joy Ellen Petersen, APRN

• Psychologist in Murray, UT
• Providers in Murray, UT by specialty
• Psychologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2013; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.