NPIMap

Individual provider Active NPI

Jared P Spackman, PA-C

  • Physician Assistant
  • West Jordan, UT
National Provider Identifier
1396757241
Registry record updated Nov 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4808078-1206 Issued in UT
Practice address
8822 South Redwood Road
C-211
West Jordan, UT 84088-8811
Phone
(801) 563-1975
Fax
(801) 563-1984
NPI assigned
Aug 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 4808078-1206 UT Primary

Addresses

Primary practice location

8822 South Redwood Road
C-211
West Jordan, UT 84088-8811

Mailing address

8822 South Redwood Road
C-211
West Jordan, UT 84088-8811
Phone (801) 563-1975

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jspackman239409@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
I20060425000777 UT Practitioner - Physician Assistant 5597775288 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
89.01 of 100Reported as group
Quality
94.06
Promoting interoperability
100
Improvement activities
40
Cost
69.32

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4808078-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services CurrentSince Apr 24, 2017 Accepting new patients
University of Utah Community Physicians Group CurrentSince Mar 1, 2019 Accepting new patients
University of Utah Community Physicians Group CurrentSince Mar 1, 2019 Accepting new patients
University of Utah Adult Services CurrentSince Apr 24, 2017 Accepting new patients
University of Utah Community Physicians Group Past Accepting new patients
Summit Pain Management PC Past Accepting new patients
Southwest Children'S Clinic Past Accepting new patients
Biomechanics Institute PLLC Past Accepting new patients

Locations

1743 Redstone Center Dr
Ste 115
Park City, UT 84098
Phone (435) 658-9200

1525 W 2100 S
Salt Lake City, UT 84119
Phone (801) 213-8841

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

Interoperability endpoints

  • Direct secure messaging: jspackman239409@direct.med.utah.edu
  • Direct secure messaging: jared.spackman.1@13794.direct.athenahealth.com

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1396757241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8822 SOUTH REDWOOD ROAD",
            "address_2": "C-211",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840888811",
            "telephone_number": "801-563-1975",
            "fax_number": "801-563-1984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8822 SOUTH REDWOOD ROAD",
            "address_2": "C-211",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840888811",
            "telephone_number": "801-563-1975",
            "fax_number": "801-563-1984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPACKMAN",
        "first_name": "JARED",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "4808078-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jspackman239409@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": "841320100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in West Jordan, UT

Sources for this page

Verify at the official NPI Registry.