Individual provider Active NPI

Jeffrey John Ekstrand, M.D.,PH.D.

  • Neurology with Special Qualifications in Child Neurology Physician
  • Salt Lake City, UT
National Provider Identifier
1477755155
Registry record updated Dec 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
6647168-1205 Issued in UT
Practice address
100 Mario Capecchi Dr
Salt Lake City, UT 84113-1103
Phone
(801) 587-7575
Fax
(801) 587-7471
NPI assigned
Jun 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 6647168-1205 UT Primary

Addresses

Primary practice location

100 Mario Capecchi Dr
Salt Lake City, UT 84113-1103

Mailing address

PO Box 413021
Salt Lake City, UT 84141-3021
Phone (801) 213-3900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20160811002662 OR Practitioner - Neurology 9739332644 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6647168-1205UTMDNeurology with Special Qualifications in Child Neurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Aug 15, 2016 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Aug 15, 2016 Accepting new patients

Locations

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

501 N Graham St
Ste 330A
Portland, OR 97227
Phone (503) 413-2050

501 N Graham St
Ste 330
Portland, OR 97227
Phone (503) 413-3600

1475 Mount Hood Ave
Ste 150
Woodburn, OR 97071
Phone (503) 874-2454

Interoperability endpoints

  • Direct secure messaging: jekstrand145365@direct.lhs.org

Organizations & group practices 3

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": "1180915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387411200000",
    "number": "1477755155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 413021",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841413021",
            "telephone_number": "801-213-3900",
            "fax_number": "801-585-3655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MARIO CAPECCHI DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-587-7575",
            "fax_number": "801-587-7471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EKSTRAND",
        "first_name": "JEFFREY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.,PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-04",
        "last_updated": "2013-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "UT",
            "license": "6647168-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.