Jackson Walter Deere, MD
Individual provider Active NPI Otolaryngology Physician · North Logan, UT
NPI 1497311369 · NPPES record last updated Aug 9, 2024
Key facts
- NPI
- 1497311369
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Otolaryngology Physician 207Y00000X
- License
- 13768482-1205 (UT)
- Practice address
- 2245 N 400 E Ste 301
North Logan, UT 84341-1892 - Phone
- (435) 753-7880
- Fax
- (435) 753-5845
- NPI assigned
- May 15, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Otolaryngology
- Education
- University of Texas Southwestern Medical School at Dallas, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cache Valley Ear Nose and Throat, PLLC
Practice addresses (Care Compare)
2245 N 400
Suite 301
North Logan, UT 84341-1892
Phone (435) 753-7880
Hospital & facility affiliations
- Intermountain Health Logan Regional Hospital
- Cache Valley Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Upper gastrointestinal (GI) endoscopy for acid reflux | 1-10 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240710002762 | UT | Practitioner - Otolaryngology | 5294060109 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cache Valley Ear Nose & Throat, PLLC | Current |
Accepting new patients |
Locations
990 S 500 W
Brigham City, UT 84302
Phone (435) 723-5868
2245 N 400 E
Ste 301
North Logan, UT 84341
Phone (435) 753-7880
169 N Gateway Dr
Ste 120
Providence, UT 84332
Phone (435) 753-7880
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 13768482-1205 | UT | Yes |
Addresses
Primary practice location
2245 N 400 E Ste 301
North Logan, UT 84341-1892
Mailing address
2245 N 400 E Ste 301
North Logan, UT 84341-1892
Phone (435) 753-7880
Other practice location 1
200 Hawkins Dr Dept Of
Iowa City, IA 52242-1009
Phone (319) 356-2201
Other providers in North Logan, UT
- Angela Karlina Cronin
- Ashley Anne Crum
- Curtis R. Canning, MD, PC
- Dana Jackson, LCSW, LLC
- Carrie Day
- Discover Wellness Center, LLC
- Susan A Doucette
- Melanie Douglass
- Matthew Joseph Edrington
- Leila Elmi-Stuart
All providers in North Logan, UT · Otolaryngology Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2024. 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.