Jacob Russell Porter, D.O

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

00000000 Issued in IL

Practice address

333 N 300 W
Salt Lake City, UT 84103-1215

Phone

(014) 637-4158

NPI assigned

Apr 12, 2017

Last updated

Aug 18, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jacob Russell Porter Professional name

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

Specialty

Emergency Medicine

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Physicians Integrated Care LLCGroup PAC ID 4284548116, 203 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Mark's Hospital Hospital, Salt Lake City, UT, CCN 460047
• Lone Peak Hospital Hospital, Draper, UT, CCN 460060

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Emergency Physicians Integrated Care, LLC

  • Emergency Medicine Physician
  • Salt Lake City, UT
  • NPI 1578598199
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lone Peak Hospital, Inc.

  dba Lone Peak Hospital

  • General Acute Care Hospital
  • Draper, UT
  • NPI 1770821571
  Care Compare affiliation
• Northern Utah Healthcare Corporation

  dba St. Mark's Hospital

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1164469243
  Care Compare affiliation

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

{
    "created_epoch": "1491955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597708800000",
    "number": "1588198063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N 300 W",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841031215",
            "telephone_number": "480-318-0354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 N 300 W",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841031215",
            "telephone_number": "014-637-4158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "JACOB",
        "middle_name": "RUSSELL",
        "credential": "D.O",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-12",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "00000000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACOB",
            "last_name": "PORTER",
            "middle_name": "RUSSELL",
            "credential": "DO",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Portable Ultrasound of Utah LLC
• Portable X-Ray of Utah LLC
• Adam Porter, MOTR/L
• Adam Seth Porter
• Alexandria Porter
• James J Porter, PHARMD
• Janesa Porter, DNP, CPNP AC/PC
• Jennifer Porter, MDA, RDN, CD, IBCLC
• Julie M. Porter, MD, PHD
• Mickayla Ashlee Porter

• Emergency Medicine Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Emergency Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.