Active NPI
Jacob Sanderson, FNP-BC
- Family Nurse Practitioner
- Logan, UT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 6231344-4405
- Practice address
- 1400 N 500 E
Logan, UT 84341-2455 - Phone
- (435) 716-2000
- NPI assigned
- Jul 3, 2019
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 6231344-4405 | UT | Primary |
Addresses
Primary practice location
1400 N 500 E
Logan, UT 84341-2455
Mailing address
573 S 1080 E
Smithfield, UT 84335-5103
Phone (435) 757-3784
Other practice location 1
30 N State St
Preston, ID 83263-1237
Phone (435) 383-6120
Other practice location 2
258 S Main St Ste 210
Logan, UT 84321-5768
Phone (435) 383-6120
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT, ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- University of South Alabama College of Medicine, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
258 S Main St
Suite 210
Logan, UT 84321-5768
Phone (435) 383-6120
30 N State St
Preston, ID 83263-1237
Phone (435) 383-6120
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sound Physicians of Wyoming, LLC | Current | Accepting new patients | |
| Rocky Mountain Emergency Specialists LLC | Emergency Medicine | Current | Accepting new patients |
| Atlas Medical Utah LLC | Current | Accepting new patients |
Locations
30 N State St
Preston, ID 83263
Phone (435) 383-6120
1010 S Medical Dr
Brigham City, UT 84302
Phone (435) 310-5800
332 W 300 N
Hyde Park, UT 84318
Phone (435) 557-0505
258 S Main St
Ste 210
Logan, UT 84321
Phone (435) 383-6120
1400 N 500 E
North Logan, UT 84341
Phone (435) 716-1000
560 W 465 N
Ste 604
Providence, UT 84332
Phone (435) 753-1600
Interoperability endpoints
- jacob.sanderson@57560418353156.direct.elationemr.com
- jacob.sanderson@371240051802116.direct.elationemr.com
Organizations & group practices 4
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.
-
- Emergency Medicine Physician
- Logan, UT
- NPI 1225078736
-
- Internal Medicine Physician
- Kalamazoo, MI
- NPI 1932957495
UT
-
- Hospitalist Physician
- Casper, WY
- NPI 1982982708
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Intermountain Health Logan Regional Hospital
- General Acute Care Hospital
- Logan, UT
- NPI 1831108497
-
dba Aegis Home Health and Hospice
- Community Based Hospice Care Agency
- Logan, UT
- NPI 1881856706
-
- Home Health Agency
- Layton, UT
- NPI 1952417214
-
dba Cache Valley Hospital
- General Acute Care Hospital
- North Logan, UT
- NPI 1952703472
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1760313600000",
"number": "1265094742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "573 S 1080 E",
"city": "SMITHFIELD",
"state": "UT",
"postal_code": "843355103",
"telephone_number": "435-757-3784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 N 500 E",
"city": "LOGAN",
"state": "UT",
"postal_code": "843412455",
"telephone_number": "435-716-2000"
}
],
"practiceLocations": [
{
"address_1": "30 N State St",
"address_purpose": "LOCATION",
"city": "Preston",
"state": "ID",
"postal_code": "832631237",
"country_code": "US",
"telephone_number": "435-383-6120",
"fax_number": "435-557-8003",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "258 S Main St Ste 210",
"address_purpose": "LOCATION",
"city": "Logan",
"state": "UT",
"postal_code": "843215768",
"country_code": "US",
"telephone_number": "435-383-6120",
"fax_number": "435-557-8003",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SANDERSON",
"first_name": "JACOB",
"name_prefix": "Mr.",
"credential": "FNP-BC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-03",
"last_updated": "2025-10-13",
"certification_date": "2025-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "UT",
"license": "6231344-4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Logan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2025; 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.