Individual provider Active NPI

Jace Melessa

  • Anesthesiology Physician
  • Provo, UT
National Provider Identifier
1639756448
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
14199918-1204 Issued in UT
Practice address
1034 N 500 W
Provo, UT 84604-3380
Phone
(702) 562-5519
NPI assigned
Mar 26, 2021
Last updated
May 7, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Anesthesiology Physician 207L00000X 14199918-1204 UT Primary

Addresses

Primary practice location

1034 N 500 W
Provo, UT 84604-3380

Mailing address

3100 N. Tenaya Way Graduate Medical Education
Las Vegas, NV 89128-0431

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250528003404 UT Practitioner - Anesthesiology 9032513213 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Kansas City Homeopathic Medical College, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain West Anesthesia LLCGroup PAC ID 9032018502, 267 clinicians

Practice addresses (Care Compare)

1034 N 500
Provo, UT 84604-3380
Phone (801) 357-7850

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
14199918-1204UTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain West Anesthesia LLC Anesthesiology CurrentSince Mar 14, 2025 Accepting new patients

Locations

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

150 W Civic Center Dr
Ste 200
Sandy, UT 84070
Phone (801) 727-2056

Organizations & group practices 1

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 1

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": "1616716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746576000000",
    "number": "1639756448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 N. TENAYA WAY GRADUATE MEDICAL EDUCATION",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 N 500 W",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043380",
            "telephone_number": "702-562-5519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELESSA",
        "first_name": "JACE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-26",
        "last_updated": "2025-05-07",
        "certification_date": "2025-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "14199918-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.