Individual provider Active NPI

Jacob Brandenburg, M.D.

  • Anesthesiology Physician
  • Salt Lake City, UT
National Provider Identifier
1366975914
Registry record updated Oct 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
10970498-1205 Issued in UT
Practice address
School of Medicine 30 North 1900 East Room 3C444
Salt Lake City, UT 84132
Phone
(801) 581-6393
NPI assigned
Apr 10, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 10970498-1205 UT Primary

Addresses

Primary practice location

School of Medicine 30 North 1900 East Room 3C444
Salt Lake City, UT 84132

Mailing address

School of Medicine 30 North 1900 East Room 3C444
Salt Lake City, UT 84132-0001
Phone (801) 581-6393

Other practice location 1

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-8211

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jbrandenburg62294@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: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210203002368 UT Practitioner - Anesthesiology 0244503464 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Utah School of Medicine, 2017
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)

1950 Circle of Hope Dr
Salt Lake City, UT 84112-5500
Phone (801) 581-8793

Hospital & facility affiliations

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
10970498-1205UTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Acuity Care Services Current Accepting new patients
University of Utah Acuity Care Services CurrentSince Nov 1, 2022 Accepting new patients
University of Utah Adult Services CurrentSince Jan 1, 2021 Accepting new patients
University of Utah Adult Services CurrentSince Jan 1, 2021 Accepting new patients
University of Utah Acuity Care Services CurrentSince Nov 1, 2022 Accepting new patients

Locations

250 E 200 S
Ste 1350
Salt Lake City, UT 84111
Phone 80158763362003

30 N 1900 E
Rm 3C444
Slc, UT 84132
Phone (801) 581-3622

1950 Circle of Hope Dr
Slc, UT 84112
Phone (801) 585-0100

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

Interoperability endpoints

  • Direct secure messaging: jbrandenburg62294@direct.med.utah.edu

Organizations & group practices 5

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": "1491782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1366975914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SCHOOL OF MEDICINE 30 NORTH 1900 EAST ROOM 3C444",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-581-6393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SCHOOL OF MEDICINE 30 NORTH 1900 EAST ROOM 3C444",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84132",
            "telephone_number": "801-581-6393"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3181 SW Sam Jackson Park Rd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972393011",
            "country_code": "US",
            "telephone_number": "503-494-8211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRANDENBURG",
        "first_name": "JACOB",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-10",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "10970498-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jbrandenburg62294@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.