Kyle Jackman, D.O

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

10323966-1204 Issued in UT

Practice address

2400 N Washington Blvd
Ogden, UT 84414-7233

Phone

(801) 786-7500

NPI assigned

May 9, 2014

Last updated

Mar 17, 2018By the provider in NPPES

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

Family Practice

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health Home Health - Ogden Home health agency, South Ogden, UT, CCN 467004
• Intermountain Health McKay-Dee Hospital Hospital, Ogden, UT, CCN 460004

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Sandy, UT
  • NPI 1942325154
  Medicare reassignment Care Compare group NPD
• Ihc Health Services Inc

  dba Budge Clinic

  • Internal Medicine Physician
  • Logan, UT
  • NPI 1912023300
  NPD
• Ihc Health Services, Inc.

  dba St George Adolescent Partial Hospitalization

  • Psychiatry Physician
  • St George, UT
  • NPI 1023843844
  NPD
• Ihc Health Services Inc

  dba Orem Community Hospital Physicians

  • Multi-Specialty Clinic/Center
  • Orem, UT
  • NPI 1588601124
  NPD (past)

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

• Ihc Health Services Inc

  dba Intermountain Health McKay-Dee Hospital

  • General Acute Care Hospital
  • Ogden, UT
  • NPI 1194749580
  Care Compare affiliation
• Ihc Health Services Inc

  dba Intermountain Health Home Health Ogden

  • Home Health Agency
  • Ogden, UT
  • NPI 1730254160
  Care Compare affiliation

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

{
    "created_epoch": "1399593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1659782969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 E 29TH ST STE 100",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022623",
            "telephone_number": "979-436-0485",
            "fax_number": "979-436-0063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 N WASHINGTON BLVD",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844147233",
            "telephone_number": "801-786-7500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2900 E 29th St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Bryan",
            "state": "TX",
            "postal_code": "778022623",
            "country_code": "US",
            "telephone_number": "979-436-0485",
            "fax_number": "979-436-0063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKMAN",
        "first_name": "KYLE",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-09",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "10323966-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Travis Ivan, DO
• Clint G. Iverson, D.M.D.
• Mary Jean Iverson, CPCI
• Richard Blaine Iverson, D.O.
• Jessica Ivy
• Angela Maria Jackson, LPC
• Matthew Jackson, PA-C, MPAS
• Jill Jacobs, RN
• Christine Renee Jacobson-Ware, RPH, DAAFM
• Becky J Jacobson, NP APRN

• Family Medicine Physician in Ogden, UT
• Providers in Ogden, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.