John M Jacobs, M.D.
Individual provider Active NPI Vascular & Interventional Radiology Physician · Murray, UT
NPI 1912947995 · NPPES record last updated Sep 12, 2012
Key facts
- NPI
- 1912947995
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Vascular & Interventional Radiology Physician 2085R0204X
- License
- 168972-1205 (UT)
- Practice address
- 5444 Green St
Murray, UT 84123-5632 - Phone
- (801) 262-8120
- Fax
- (801) 262-5721
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 17
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Diagnostic Radiology
- Education
- University of Missouri, Columbia School of Medicine, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ihc Health Services Inc
Tellica Imaging - Washington LLC
Practice addresses (Care Compare)
1380 E Medical Ctr Dr
St George, UT 84790-2123
2941 S 38TH St
Suite E
Tacoma, WA 98409-5647
Phone (253) 534-8689
Hospital & facility affiliations
- Intermountain Medical Center
- Intermountain Health McKay-Dee Hospital
- Intermountain Health Cedar City Hospital
- Intermountain Health Riverton Hospital
- LDS Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in UT, WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040206000238 | UT | Practitioner - Diagnostic Radiology | 6608769286 | Reassigns benefits to 4 organizations |
| I20260318002721 | WA | Practitioner - Diagnostic Radiology | 6608769286 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-8403 | ID | MD | Diagnostic Radiology Physician |
| 168972-1205 | UT | MD | Vascular & Interventional Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ihc Health Services Inc | Family Medicine | Current | Accepting new patients |
| Tellica Imaging - Washington LLC | Diagnostic Radiology | Current |
Accepting new patients |
| Mountain Medical Physician Specialists PC | Body Imaging | Current |
Accepting new patients |
| Tellica Imaging, LLC | Current |
Accepting new patients | |
| Ihc Health Services Inc | Current | Accepting new patients | |
| Ihc Health Services Inc | Current |
Accepting new patients | |
| Tellica Imaging, LLC | Diagnostic Radiology | Current |
Accepting new patients |
| Ihc Health Services Inc | Current |
Accepting new patients | |
| Ihc Health Services, Inc. | Current |
Accepting new patients | |
| Tellica Imaging, LLC | Current |
Accepting new patients | |
| Tellica Imaging, LLC | Current |
Accepting new patients | |
| Ihc Health Services, Inc. | Current |
Accepting new patients | |
| Tellica Imaging, LLC | Current |
Accepting new patients | |
| MMPS Murray | Past | Accepting new patients | |
| Central Utah Radiology, PC | Diagnostic Radiology | Past | Accepting new patients |
| University Radiology Associates | Body Imaging | Past | Accepting new patients |
Locations
1501 Hiland Ave
Burley, ID 83318
Phone (208) 678-4444
700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555
5334 S Woodrow St
#100
Salt Lake City, UT 84107
Phone (801) 284-1702
5323 S Woodrow St
Ste 101
Salt Lake City, UT 84107
Phone (801) 313-4118
5444 S Green St
Salt Lake City, UT 84123
Phone (801) 262-2647
5295 S Commerce Dr
Ste 550
Salt Lake City, UT 84107
Phone (801) 313-4110
5217 S State St
Ste 200
Salt Lake City, UT 84107
Phone (208) 417-5100
5323 S Woodrow St
Salt Lake City, UT 84107
Phone (801) 261-8346
400 C St
Salt Lake Cty, UT 84143
Phone (435) 688-4080
36 S Street St
Ste 2200
Salt Lake Cty, UT 84111
Phone (385) 622-0669
296 E 3900 S
Salt Lake Cty, UT 84107
Phone (801) 262-8120
1200 E 3900 S
Slc, UT 84124
Phone (801) 268-7111
50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292
1486 E Skyline Dr
South Ogden, UT 84405
Phone (801) 475-4552
1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355
1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992
544 S 400 E
St George, UT 84770
Phone (435) 688-4000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 168972-1205 | UT | |
| Vascular & Interventional Radiology Physician | 2085R0204X | 168972-1205 | UT | Yes |
| Diagnostic Radiology Physician | 2085R0202X | M-8403 | ID |
Addresses
Primary practice location
5444 Green St
Murray, UT 84123-5632
Mailing address
5444 Green St
Murray, UT 84123-5632
Phone (801) 262-2647
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07258 | Medicaid | UT |
Other providers in Murray, UT
- Lauren Jackson
- Raneka Sydni Jackson
- Vittoria Rosaria Zaccardi Jackson
- Jenny Alyssa Jacobs
- John Christopher Jacobs Jr.
- Natasha Jacobson
- A Alexander Jacoby
- Jacquez Counseling, PLLC
- Jacob Eugene Jacquez
- Solomon Jakomino
All providers in Murray, UT · Vascular & Interventional Radiology Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.