Individual provider Active NPI

Bruce W Jasper, PH.D.

  • Clinical Neuropsychologist
  • Murray, UT
National Provider Identifier
1710177357
Registry record updated Mar 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
11569209-2501 Issued in UT
Practice address
5171 S Cottonwood St Ste 810
Murray, UT 84107-5705
Phone
(801) 507-9800
NPI assigned
Jul 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 001037 IA
Clinical Neuropsychologist 103G00000X 11569209-2501 UT Primary

Addresses

Primary practice location

5171 S Cottonwood St Ste 810
Murray, UT 84107-5705

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 507-9800

Other practice location 1

10808 S River Front Pkwy Ste 355
South Jordan, UT 84095-6300
Phone (801) 984-2881

Other practice location 2

411 10th St SE Ste 150
Cedar Rapids, IA 52403-2449
Phone (319) 369-7507

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)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
001037IAMDMental Health Counselor
11569209-2501UTMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Regional Medical Center Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614816000000",
    "number": "1710177357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-507-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5171 S COTTONWOOD ST STE 810",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075705",
            "telephone_number": "801-507-9800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10808 S River Front Pkwy Ste 355",
            "address_purpose": "LOCATION",
            "city": "South Jordan",
            "state": "UT",
            "postal_code": "840956300",
            "country_code": "US",
            "telephone_number": "801-984-2881",
            "fax_number": "801-984-4171",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "411 10th St SE Ste 150",
            "address_purpose": "LOCATION",
            "city": "Cedar Rapids",
            "state": "IA",
            "postal_code": "524032449",
            "country_code": "US",
            "telephone_number": "319-369-7507",
            "fax_number": "319-369-8251",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JASPER",
        "first_name": "BRUCE",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-30",
        "last_updated": "2021-03-04",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IA",
            "license": "001037",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "UT",
            "license": "11569209-2501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.