Jacob Samuel Forbes, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1329004-1204 Issued in UT

Practice address

3580 W 9000 S
West Jordan, UT 84088-8812

Phone

(801) 561-8888

NPI assigned

Apr 10, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

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, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Utah Regional Hospitalists LLCGroup PAC ID 4789807165, 119 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Holy Cross Hospital-Jordan Valley Hospital, West Jordan, UT, CCN 460051
• St Mark'S Hospital Hospital, Salt Lake City, UT, CCN 460047

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 and National Provider Directory roles.

• Utah Regional Hospitalists LLC

  • Hospitalist Physician
  • Murray, UT
  • NPI 1962821223
  Medicare reassignment Care Compare group NPD
• Utah Regional Hospitalists LLC

  • Hospitalist Physician
  • Idaho Falls, ID
  • NPI 1740715507
  NPD

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

• Catholic Health Initiatives Colorado

  • General Acute Care Hospital
  • West Jordan, UT
  • NPI 1801591391
  Care Compare affiliation
• Northern Utah Healthcare Corporation

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1164469243
  Care Compare affiliation

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

{
    "created_epoch": "1586476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1841819794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 E CLARK BASS BLVD STE 301",
            "city": "MCALESTER",
            "state": "OK",
            "postal_code": "745014269",
            "telephone_number": "918-421-6081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3580 W 9000 S",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840888812",
            "telephone_number": "801-561-8888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4 E Clark Bass Blvd Ste 301",
            "address_purpose": "LOCATION",
            "city": "McAlester",
            "state": "OK",
            "postal_code": "745014269",
            "country_code": "US",
            "telephone_number": "918-421-6081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORBES",
        "first_name": "JACOB",
        "middle_name": "SAMUEL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-10",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "7293",
            "primary": false
        },
        {
            "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": "1329004-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackie Anne Fonua, PA-C
• Foot & Ankle Institute of Utah LLC
• Foot and Ankle Specialists, PLLC
• Foottent LLC
• Ahinoamah Forbes
• Haley Ford
• Jessica Ford
• Nicole Renae Ford
• Melody Forsyth, APRN
• Sydney Foulk

• Family Medicine Physician in West Jordan, UT
• Providers in West Jordan, 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 Sep 19, 2023; 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.