NPIMap

Individual provider Active NPI

Jeff Hale Pettey, MD

  • Ophthalmology Physician
  • SLC, UT
National Provider Identifier
1346494911
Registry record updated Nov 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
7152089-1205 Issued in UT
Practice address
65 Mario Capecchi Dr
SLC, UT 84132-5000
Phone
(801) 651-4758
NPI assigned
Nov 10, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 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 7152089-1205 UT Primary

Addresses

Primary practice location

65 Mario Capecchi Dr
SLC, UT 84132-5000

Mailing address

65 Mario Capecchi Dr
SLC, UT 84132-5000
Phone (801) 651-4758

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jpettey28681@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
I20110721000354 UT Practitioner - Ophthalmology 2365610128 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Ohio State University College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

65 S Mario Capecchi Dr
Salt Lake City, UT 84132-0005
Phone (801) 581-2352

Hospital & facility affiliations

  • University of Utah Hospital and Clinics Hospital, Salt Lake City, UT, CCN 460009

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery139

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7152089-1205UTMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services CurrentSince Apr 1, 2015 Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Adult Services CurrentSince Apr 1, 2015 Accepting new patients
Bronson Lakeview Hospital Past Accepting new patients

Locations

127 S 500 E
Ste 200
Salt Lake City, UT 84102

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

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

Interoperability endpoints

  • Direct secure messaging: jpettey28681@direct.med.utah.edu

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.

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": "1226275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1346494911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 MARIO CAPECCHI DR",
            "city": "SLC",
            "state": "UT",
            "postal_code": "841325000",
            "telephone_number": "801-651-4758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 MARIO CAPECCHI DR",
            "city": "SLC",
            "state": "UT",
            "postal_code": "841325000",
            "telephone_number": "801-651-4758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTEY",
        "first_name": "JEFF",
        "middle_name": "HALE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-10",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "UT",
            "license": "7152089-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpettey28681@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 SLC, UT

Sources for this page

Verify at the official NPI Registry.