Active NPI
Jaclyn Perlick
- Community Health Worker
- Ogden, UT
National Provider Identifier
1609657170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 237 26TH St
Ogden, UT 84401-3105 - Phone
- (801) 625-3700
- NPI assigned
- Oct 11, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
237 26TH St
Ogden, UT 84401-3105
Mailing address
237 26TH St
Ogden, UT 84401-3105
Phone (801) 625-3700
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000055266 | Other | UT | MEDICARE PIN |
| 260022408 | Other | UT | RAILROAD MEDICARE |
| 8760003008007 | Medicaid | UT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1696982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696982400000",
"number": "1609657170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "237 26TH ST",
"city": "OGDEN",
"state": "UT",
"postal_code": "844013105",
"telephone_number": "801-625-3700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "237 26TH ST",
"city": "OGDEN",
"state": "UT",
"postal_code": "844013105",
"telephone_number": "801-625-3700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERLICK",
"first_name": "JACLYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-10-11",
"last_updated": "2023-10-11",
"certification_date": "2023-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PIN",
"identifier": "000055266",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "260022408",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8760003008007",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ogden, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.