Mardiene Jeffs, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

102860-1206 Issued in UT

Practice address

520 Medical Dr
210
Bountiful, UT 84010-4968

Phone

(801) 296-5805

NPI assigned

Jan 17, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Wade Family Medicine, Inc.

  • Family Medicine Physician
  • Bountiful, UT
  • NPI 1558597831
  NPD

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770635195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "352 W 250 N",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107020",
            "telephone_number": "801-856-0909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 MEDICAL DR",
            "address_2": "210",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840104968",
            "telephone_number": "801-296-5805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEFFS",
        "first_name": "MARDIENE",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "102860-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jared J Tyson MD PC
• Carmela J Javellana, MD
• Garrett Tanner Jefferies
• Jeffery R. Oka, M.D., P.C.
• Sydney R Jeffries, LCSW
• Erik Jenkins, LCSW
• Kristopher B Jenkins, FNP-C
• Elva Michelle Jensen
• Jill Jensen, CSW
• Joseph D. Jensen, MD

• Physician Assistant in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Physician Assistant in Utah

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.