NPIMap

Individual provider Active NPI

Jordan W Merrill, MD

  • Psychiatry Physician
  • Eagle, ID
National Provider Identifier
1902197007
Registry record updated Nov 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
M-13001 Issued in ID
Practice address
1032 S. Bridgeway PL.
Ste 110
Eagle, ID 83616
Phone
(208) 475-0800
Fax
(208) 639-0901
NPI assigned
Apr 22, 2011
Last updated
Nov 22, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X M-13001 ID Primary

Addresses

Primary practice location

1032 S. Bridgeway PL.
Ste 110
Eagle, ID 83616

Mailing address

1032 S. Bridgeway PL.
Ste 110
Eagle, ID 83616
Phone (208) 475-0800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmerrill432520@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
I20200421003235 UT Practitioner - Psychiatry 2668772195 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-13001IDMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Acuity Care Services CurrentSince Apr 14, 2020 Accepting new patients
University of Utah Acuity Care Services Current Accepting new patients
North Canyon Medical Center Inc. Current Accepting new patients
University of Utah Behavioral Health Services Psychiatry CurrentSince Mar 14, 2020 Accepting new patients
University of Utah Behavioral Health Services CurrentSince Mar 14, 2020 Accepting new patients
University of Utah Behavioral Health Services Psychiatry Current Accepting new patients
University of Utah Acuity Care Services CurrentSince Apr 14, 2020 Accepting new patients

Locations

267 N Canyon Dr
Gooding, ID 83330
Phone (208) 934-4433

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

501 S Chipeta Way
Slc, UT 84108
Phone (801) 581-7951

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1303430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637539200000",
    "number": "1902197007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1032 S. BRIDGEWAY PL.",
            "address_2": "STE 110",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "83616",
            "telephone_number": "208-475-0800",
            "fax_number": "208-639-0901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 S. BRIDGEWAY PL.",
            "address_2": "STE 110",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "83616",
            "telephone_number": "208-475-0800",
            "fax_number": "208-639-0901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERRILL",
        "first_name": "JORDAN",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-22",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ID",
            "license": "M-13001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmerrill432520@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 Eagle, ID

Sources for this page

Verify at the official NPI Registry.