Jesse David Jensen, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

8963761-1204 Issued in UT

Practice address

2376 N 400 E
Ste 203
Tooele, UT 84074-3413

Phone

(801) 966-1403

Fax

(801) 964-6478

NPI assigned

Apr 21, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Dermatology

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

West Valley DermatologyGroup PAC ID 5496078479, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Quality

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Interoperability endpoints

• Direct secure messaging: jesse.jensen@epiphanyderm.emadirect.md

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.

• West Valley Dermatology

  • Dermatology Physician
  • Salt Lake City, UT
  • NPI 1548680184
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1271808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457308800000",
    "number": "1619294337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3465 S PIONEER PKWY",
            "address_2": "SUITE 1",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841202076",
            "telephone_number": "801-966-1403",
            "fax_number": "801-964-6478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2376 N 400 E",
            "address_2": "STE 203",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "840743413",
            "telephone_number": "801-966-1403",
            "fax_number": "801-964-6478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "JESSE",
        "middle_name": "DAVID",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-21",
        "last_updated": "2016-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "UT",
            "license": "8963761-1204",
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "UT",
            "license": "8963761-1204",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jay M. Spector,M.D.,LLC
• Jed C Winder OD, PC
• Candice Jemison
• Jeramy Rawn Jenkins, AU.D., CCC-A
• Suzanne Renee Jenkins, RRT
• Jim J. Gould, MD PC
• John L Bishop DMD PC
• Aubra Johnson
• Beau William Johnson
• Dani Johnson

• Dermatology Physician in Tooele, UT
• Providers in Tooele, UT by specialty
• Dermatology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2016; 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.