Active NPI
Jackson R Fitzgerald, MD
- Anesthesiology Physician
- Payson, UT
National Provider Identifier
1730283268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 185769-1205
- Practice address
- 1000 E 100 N
Payson, UT 84651-1600 - Phone
- (800) 748-4868
- Fax
- (801) 733-5872
- NPI assigned
- Sep 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 185769-1205 | UT | Primary |
Addresses
Primary practice location
1000 E 100 N
Payson, UT 84651-1600
Mailing address
3 S Hillside Dr
Elk Ridge, UT 84651-8501
Phone (801) 423-6468
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 212704 | Other | UT | DESERET MUTUAL |
| 107007001102 | Other | UT | IHC |
| PR00525 | Other | UT | MOLINA |
| 32664 | Other | UT | PEHP |
| QM0000076595 | Other | UT | ALTIUS |
| 52944 | Other | UT | HEALTHY U |
| 870525882FI1 | Other | UT | EDUCATORS MUTUAL |
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 185769-1205 | UT | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730283268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 S HILLSIDE DR",
"city": "ELK RIDGE",
"state": "UT",
"postal_code": "846518501",
"telephone_number": "801-423-6468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 E 100 N",
"city": "PAYSON",
"state": "UT",
"postal_code": "846511600",
"telephone_number": "800-748-4868",
"fax_number": "801-733-5872"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FITZGERALD",
"first_name": "JACKSON",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "UT",
"license": "185769-1205",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DESERET MUTUAL",
"identifier": "212704",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IHC",
"identifier": "107007001102",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOLINA",
"identifier": "PR00525",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEHP",
"identifier": "32664",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALTIUS",
"identifier": "QM0000076595",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHY U",
"identifier": "52944",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EDUCATORS MUTUAL",
"identifier": "870525882FI1",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Payson, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.