Jacob Buckway, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

94443013102 Issued in UT

Practice address

5475 S 500 E
Ogden, UT 84405-6905

Phone

(801) 479-2111

NPI assigned

Dec 6, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• NPH Anesthesia of Utah, LLC

  • Anesthesiology Physician
  • Ogden, UT
  • NPI 1366077273
  Medicare reassignment NPD

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

{
    "created_epoch": "1638748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1346908464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1059 N 175 E",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840412477",
            "telephone_number": "801-719-0045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5475 S 500 E",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844056905",
            "telephone_number": "801-479-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKWAY",
        "first_name": "JACOB",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-06",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "UT",
            "license": "94443013102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael H Buch, MD
• Alyssa Buchhammer, RN
• Felicia Buck
• Lori Buck
• Erik Kenneth Buckmiller
• Paul Bugnet, ATC
• Kathreen Buhler
• Michael Lonnie Bullard, M.D.
• Robert Michael Bulloch, LCSW
• Lydia Davidson Bullock, LCSW

• Certified Registered Nurse Anesthetist in Ogden, UT
• Providers in Ogden, UT by specialty
• Certified Registered Nurse Anesthetist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.