Jerry William Hussong, DDS MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

3403921205 Issued in UT

Practice address

500 S Chipeta Way
Salt Lake City, UT 84108-1221

Phone

(801) 583-2787

Fax

(801) 584-5141

NPI assigned

Mar 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Richard Bernert, LLC

  • Clinical Medical Laboratory
  • Scottsdale, AZ
  • NPI 1912234618
  NPD
• Consultants for Path & Lab Med Inc, a Medical Group

  • Specialist
  • West Hollywood, CA
  • NPI 1588691414
  NPD (past)
• CPLM Pathology Outreach Services

  • Anatomic Pathology & Clinical Pathology Physician
  • Los Angeles, CA
  • NPI 1235460890
  NPD (past)
• Mid-Atlantic Pathology Services, Inc.

  • Clinical Medical Laboratory
  • MC Lean, VA
  • NPI 1245302009

  Anatomic Pathology & Clinical Pathology

  NPD (past)
• Seacoast Pathology Inc

  • Clinical Medical Laboratory
  • Exeter, NH
  • NPI 1154651230
  NPD (past)

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

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383004800000",
    "number": "1346201209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S CHIPETA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081221",
            "telephone_number": "801-583-2787",
            "fax_number": "801-584-5141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S CHIPETA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081221",
            "telephone_number": "801-583-2787",
            "fax_number": "801-584-5141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUSSONG",
        "first_name": "JERRY",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "DDS MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-30",
        "last_updated": "2013-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": "NV",
            "license": "9291",
            "primary": false
        },
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": "CA",
            "license": "G86484",
            "primary": false
        },
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": "UT",
            "license": "3403921205",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NV",
            "license": "9291",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "G86484",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "UT",
            "license": "3403921205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200225018",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vanessa L. Husmann, MD
• Mohamed Hussein
• Mustaf Hussein
• Alicia Husselbee
• Patrick G. Hussey, DO
• Hutchings Family Dentistry PC
• Alison Hutchings
• Brent R. Hutchings, D.D.S.
• Carina Hutchings
• Lissa Anne Hutchings, NP-C

• Anatomic Pathology & Clinical Pathology Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Anatomic Pathology & Clinical Pathology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.