NPIMap

Individual provider Active NPI

Jason D Henrie

  • Family Nurse Practitioner
  • Provo, UT
National Provider Identifier
1629252424
Registry record updated Dec 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4746028-4405 Issued in UT
Practice address
1055 N 300 W Ste 308
Provo, UT 84604-3373
Phone
(801) 379-6700
Fax
(801) 379-6800
NPI assigned
Dec 28, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4746028-4405 UT Primary

Addresses

Primary practice location

1055 N 300 W Ste 308
Provo, UT 84604-3373

Mailing address

1055 N 300 W Ste 308
Provo, UT 84604-3373
Phone (801) 379-6700

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
I20080620000133 UT Practitioner - Nurse Practitioner 5092886986 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Utah Valley Radiology Associates IncGroup PAC ID 1759286990, 35 clinicians
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

280 River Park Dr
Suite 120
Provo, UT 84604-5796
Phone (801) 229-2011

331 N 400
Orem Hospital PG
Orem, UT 84057-1950
Phone (801) 224-4080

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4746028-4405UTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Riverwoods Urgent Care Center LC CurrentSince May 1, 2008 Accepting new patients
Ihc Health Services, Inc. CurrentSince Apr 10, 2017 Accepting new patients
Ihc Health Services Inc CurrentSince Apr 10, 2017 Accepting new patients
Ihc Health Services Inc Family Medicine Current Accepting new patients

Locations

331 N 400 W
Orem, UT 84057
Phone (801) 224-4080

1034 N 500 W
Provo, UT 84604
Phone (801) 362-4119

280 River Park Dr
Ste 120
Provo, UT 84604
Phone (601) 229-2011

1055 N 300 W
Ste 104
Provo, UT 84604
Phone (801) 357-7525

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/15493/brand/1/csg/1/fhir/r4

Organizations & group practices 5

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.

Hospital & facility affiliations 7

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": "1198800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198800000000",
    "number": "1629252424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 300 W STE 308",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043373",
            "telephone_number": "801-379-6700",
            "fax_number": "801-379-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N 300 W STE 308",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043373",
            "telephone_number": "801-379-6700",
            "fax_number": "801-379-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRIE",
        "first_name": "JASON",
        "middle_name": "D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-28",
        "last_updated": "2007-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "4746028-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.