NPIMap

Individual provider Active NPI

Jordan Robert McQueen, PA-C

  • Surgical Physician Assistant
  • Salt Lake City, UT
National Provider Identifier
1861776494
Registry record updated Nov 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
8105342-1206 Issued in UT
Practice address
24 S 1100 E
Suite 101
Salt Lake City, UT 84102-1500
Phone
(801) 355-6468
Fax
(801) 355-3450
NPI assigned
Sep 30, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 8105342-1206 UT Primary

Addresses

Primary practice location

24 S 1100 E
Suite 101
Salt Lake City, UT 84102-1500

Mailing address

24 S 1100 E
Suite 101
Salt Lake City, UT 84102-1500
Phone (801) 355-6468

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmcqueen388134@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111111000269 UT Practitioner - Physician Assistant 2668646530 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

50 N Medical Dr
Salt Lake City, UT 84132-0001
Phone (801) 581-2121

50 N Medical Dr
Salt Lake City, UT 84132-0100
Phone (801) 213-2995

590 S Wakara Way
Salt Lake City, UT 84108-1200
Phone (801) 587-7109

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Group of Utah Inc CurrentSince Sep 1, 2019 Accepting new patients
University of Utah Adult Services CurrentSince Dec 1, 2019 Accepting new patients
University of Utah Adult Services CurrentSince Dec 1, 2019 Accepting new patients
Bronson Lakeview Hospital Past Accepting new patients

Locations

165 N University Ave
Farmington, UT 84025
Phone (801) 213-3200

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

590 S Wakara Way
Slc, UT 84108
Phone (801) 587-7005

2530 W 4700 S
Ste B8
Taylorsville, UT 84129
Phone (801) 967-5866

3580 W 90th S
West Jordan, UT 84088
Phone (801) 263-0810

Interoperability endpoints

  • Direct secure messaging: jmcqueen388134@direct.med.utah.edu

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1317340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637366400000",
    "number": "1861776494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 S 1100 E",
            "address_2": "SUITE 101",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021500",
            "telephone_number": "801-355-6468",
            "fax_number": "801-355-3450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 S 1100 E",
            "address_2": "SUITE 101",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021500",
            "telephone_number": "801-355-6468",
            "fax_number": "801-355-3450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCQUEEN",
        "first_name": "JORDAN",
        "middle_name": "ROBERT",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-30",
        "last_updated": "2021-11-20",
        "certification_date": "2021-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "UT",
            "license": "8105342-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmcqueen388134@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.