NPIMap

Individual provider Active NPI

Rachael Sue Jacoby, MD

  • Ophthalmology Physician
  • Salt Lake City, UT
National Provider Identifier
1265659213
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
5764061-1205 Issued in UT
Practice address
65 Mario Capecchi Dr
Salt Lake City, UT 84132-0001
Phone
(801) 581-2352
NPI assigned
Apr 19, 2007
Last updated
Oct 21, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 5764061-1205 UT Primary

Addresses

Primary practice location

65 Mario Capecchi Dr
Salt Lake City, UT 84132-0001

Mailing address

PO Box 413075
Salt Lake City, UT 84141-3075
Phone (801) 213-3900

Other identifiers 2

IdentifierTypeStateIssuer
60966OtherWIDEAN HEALTH INSURANCE
1265659213MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rjacoby54713@direct.med.utah.edu Direct University of Utah

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
I20070613000275 UT Practitioner - Pediatric MedicinePractitioner - Ophthalmology 1052419199 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Creighton University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Retina Associates of Utah PCGroup PAC ID 0244130821, 9 clinicians

Practice addresses (Care Compare)

2132 N Robins Dr
Layton, UT 84041-7059
Phone (801) 775-8222

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.8 of 100Reported as group
Quality
97.61
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
89.77 of 100Reported as group
Quality
91.47
Promoting interoperability
100
Improvement activities
40
Cost
74.42

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5764061-1205UTMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services Current Accepting new patients
University of Utah Pediatric Services CurrentSince Feb 12, 2017 Accepting new patients
Retina Associates of Utah, PLLC Ophthalmology CurrentSince Feb 5, 2024 Accepting new patients
University of Utah Adult Services CurrentSince Feb 1, 2015 Accepting new patients
University of Utah Pediatric Services Current Accepting new patients
University of Utah Adult Services CurrentSince Feb 1, 2015 Accepting new patients
University of Utah Pediatric Services CurrentSince Feb 12, 2017 Accepting new patients

Locations

2132 N Robins Dr
Layton, UT 84041
Phone (801) 728-0600

810 S 100 W
Ste C
Logan, UT 84321
Phone (435) 752-1010

65 S Mario Capecchi Dr
Salt Lake City, UT 84132
Phone (801) 581-2352

5169 S Cottonwood St
Ste 630
Salt Lake Cty, UT 84107
Phone (801) 281-3030

100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Interoperability endpoints

  • Direct secure messaging: rjacoby54713@direct.med.utah.edu

Organizations & group practices 7

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 3

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": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1265659213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 413075",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841413075",
            "telephone_number": "801-213-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 MARIO CAPECCHI DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-581-2352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBY",
        "first_name": "RACHAEL",
        "middle_name": "SUE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-19",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "UT",
            "license": "5764061-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH INSURANCE",
            "identifier": "60966",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265659213",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rjacoby54713@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.