Jacob Rodriguez
Individual provider Active NPI Physician Assistant · Garden City, UT
NPI 1316675382 · NPPES record last updated Nov 20, 2024
Key facts
- NPI
- 1316675382
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 14190579-1206 (UT)
- Practice address
- 325 W Logan Rd
Garden City, UT 84028-7754 - Phone
- (208) 232-7862
- NPI assigned
- Aug 9, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Health West Inc
Practice addresses (Care Compare)
325 W Logan Rd
Garden City, UT 84028-7754
Phone (208) 232-7862
5 W 200
Brigham City, UT 84302-2109
Phone (208) 232-7862
Hospital & facility affiliations
- Brigham City Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in UT, ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250207003296 | UT | Practitioner - Physician Assistant | 3577093343 | Reassigns benefits to 1 organization |
| I20250530002862 | ID | Practitioner - Physician Assistant | 3577093343 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14190579-1206 | UT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Health West, Inc. | Family Medicine | Current | Accepting new patients |
| Health West, Inc. | Family Medicine | Current | Accepting new patients |
| Health West, Inc. | Current |
Accepting new patients | |
| Health West, Inc. | Family Medicine | Current | Accepting new patients |
| Health West, Inc. | Current |
Accepting new patients | |
| Health West, Inc. | Family Medicine | Current |
Accepting new patients |
| Health West, Inc. | Current | Accepting new patients | |
| Health West, Inc. | Past | Accepting new patients | |
| Health West, Inc. | Past | Accepting new patients |
Locations
823 Reed St
American Falls, ID 83211
Phone (208) 226-2822
152 S 4th St
Montpelier, ID 83254
Phone (208) 847-2108
500 S 11th Ave
Ste 400
Pocatello, ID 83201
465 Memorial Dr
Pocatello, ID 83201
Phone (208) 234-4700
880 W Quinn Rd
Pocatello, ID 83202
Phone (208) 238-2000
5 W 200 N
Brigham City, UT 84302
Phone (435) 723-6033
1515 N 400 E
Ste 104
North Logan, UT 84341
Phone (435) 755-8424
517 W 100 N
Ste 110
Providence, UT 84332
Phone (435) 755-6075
Interoperability endpoints
- jacob.rodriguez.1@16258.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 14190579-1206 | UT | Yes |
Addresses
Primary practice location
325 W Logan Rd
Garden City, UT 84028-7754
Mailing address
500 S 11TH Ave Ste 400
Pocatello, ID 83201-4880
Phone (208) 232-7862
Other providers in Garden City, UT
- Health West, Inc.
- Health West, Inc.
- Health West, Inc.
- Kam E Jarman
- Taya Rae Peterson
- Selanie Ann Sanone
- Tracy Ann Seel
- Mark C. Weston
All providers in Garden City, UT · Physician Assistant in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.