Jacob Lamar Pugh, PA-C
Individual provider Active NPI Physician Assistant · Santa Clara, UT
NPI 1396227146 · NPPES record last updated Nov 16, 2020
Key facts
- NPI
- 1396227146
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 10959210-1206 (UT)
- Practice address
- 2432 Concord Ave
Santa Clara, UT 84765-5621 - Phone
- (435) 429-0944
- NPI assigned
- Aug 29, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Aems
Practice addresses (Care Compare)
250 Country Club Pkwy
Spring Creek, NV 89815-5830
Phone (775) 738-3000
2511 Mountain City Hwy
Elko, NV 89801-4496
Phone (775) 993-2800
Hospital & facility affiliations
- St. George Regional Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in UT, NV
- 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 |
|---|---|---|---|---|
| I20180919003213 | UT | Practitioner - Physician Assistant | 2062763790 | |
| I20220315001206 | NV | Practitioner - Physician Assistant | 2062763790 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10959210-1206 | UT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aspen Quick Care PLLC | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10959210-1206 | UT | Yes |
Addresses
Primary practice location
2432 Concord Ave
Santa Clara, UT 84765-5621
Mailing address
2432 Concord Ave
Santa Clara, UT 84765-5621
Phone (435) 429-0944
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | medreview@reverehealth.com | Central Utah Clinic, P.C. |
Other providers in Santa Clara, UT
- Whittnee Kulanakea Nihipali
- Kevin Okeefe
- Jenna M Pacelli
- Possibilities ABA Utah LLC
- Elinor Priest
- Bethany Quigley
- Red Rock C & C Drip Spa LLC
- Jay D Redd
- McKenzie VI Reynolds
- Lauren Sperduto Roberts
All providers in Santa Clara, 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 16, 2020. 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.