NPIMap

Individual provider Active NPI

Jeremiah Andrew Alt, M.D., PH.D.

  • Otolaryngology Physician
  • Portland, OR
National Provider Identifier
1598968380
Registry record updated Oct 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD156611 Issued in OR
Practice address
3303 SW Bond Ave # Ch5E
Portland, OR 97239-3098
Phone
(503) 494-5678
Fax
(503) 494-4631
NPI assigned
Jun 7, 2007
Last updated
Oct 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X TRN11153 FL
Otolaryngology Physician 207Y00000X MD156611 OR Primary

Addresses

Primary practice location

3303 SW Bond Ave # Ch5E
Portland, OR 97239-3098

Mailing address

3303 SW Bond Ave # Ch5E
Portland, OR 97239-3098
Phone (503) 494-5678

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jalt67597@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
I20130715000335 UT Practitioner - Otolaryngology 5890951636 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Wayne State University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

50 N Medical Dr
Salt Lake City, UT 84132-0100
Phone (801) 585-6387

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.77 of 100Reported as group
Quality
91.47
Promoting interoperability
100
Improvement activities
40
Cost
74.42

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TRN11153FLMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services Otolaryngology CurrentSince Feb 1, 2015 Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Pediatric Services CurrentSince May 1, 2022 Accepting new patients
University of Utah Pediatric Services CurrentSince May 1, 2022 Accepting new patients
University of Utah Pediatric Services Current Accepting new patients
University of Utah Adult Services CurrentSince Feb 1, 2015 Accepting new patients
Bronson Lakeview Hospital Surgery Past Accepting new patients

Locations

100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109

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

Interoperability endpoints

  • Direct secure messaging: jalt67597@direct.med.utah.edu

Organizations & group practices 7

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634342400000",
    "number": "1598968380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3303 SW BOND AVE # CH5E",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393098",
            "telephone_number": "503-494-5678",
            "fax_number": "503-494-4631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303 SW BOND AVE # CH5E",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393098",
            "telephone_number": "503-494-5678",
            "fax_number": "503-494-4631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALT",
        "first_name": "JEREMIAH",
        "middle_name": "ANDREW",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-07",
        "last_updated": "2021-10-16",
        "certification_date": "2021-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "TRN11153",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OR",
            "license": "MD156611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jalt67597@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": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.