Individual provider Active NPI

Jarle Zenoa Meservy, M.D.

  • Psychiatry Physician
  • Provo, UT
National Provider Identifier
1912952284
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
13735041 Issued in UT
Practice address
750 N Freedom Blvd Ste 300
Provo, UT 84601-1690
Phone
(801) 373-4760
NPI assigned
May 24, 2006
Last updated
Apr 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 13735041 UT Primary
Child & Adolescent Psychiatry Physician 2084P0804X MD09268 RI

Addresses

Primary practice location

750 N Freedom Blvd Ste 300
Provo, UT 84601-1690

Mailing address

750 N Freedom Blvd Ste 300
Provo, UT 84601-1690
Phone (801) 373-4760

Other identifiers 4

IdentifierTypeStateIssuer
7010556MedicaidRI
22886-8OtherRIBLUE CROSS
410526OtherRIBLUE CHIP
15-56484OtherRIUNITED BEHAVIORAL HEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, VI, UT3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20060118001055 RI Practitioner - Psychiatry 5799709622 Reassigns benefits to 1 organization
I20190118002697 VI Practitioner - Psychiatry 5799709622 Reassigns benefits to 2 organizations
I20240515002955 UT Practitioner - Psychiatry 5799709622 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

750 N Freedom Blvd
Provo, UT 84601-1677
Phone (801) 373-4760

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13735041UTMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emma Pendleton Bradley Hospital Psychiatry CurrentSince Jun 29, 2011 Accepting new patients
Wasatch Behavioral Health Special Service District CurrentSince May 2, 2024 Accepting new patients
VI Government Hospital and Health Facilities Corp Current Accepting new patients
Emma Pendleton Bradley Hospital CurrentSince Jun 29, 2011 Accepting new patients
Wasatch Behavioral Health Special Service District CurrentSince May 2, 2024 Accepting new patients
The St Thomas East End Medical Center Corporation CurrentSince Nov 13, 2018 Accepting new patients

Locations

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

1011 Veterans Memorial Pkwy
Riverside, RI 02915
Phone (401) 432-1000

578 E 300 S
American Fork, UT 84003
Phone (801) 763-5010

1165 E 300 N
Provo, UT 84606
Phone (801) 319-1142

580 E 600 S
Provo, UT 84606
Phone (801) 373-7443

750 N Freedom Blvd
Provo, UT 84601
Phone (801) 373-0639

750 N Freedom Blvd
Ste 300
Provo, UT 84601
Phone (801) 372-4760

4605 Tutu Park Mall
Ste 207
St Thomas, VI 00802
Phone (340) 775-3700

9048 Sugar Est
St Thomas, VI 00802
Phone (340) 693-6211

Organizations & group practices 6

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": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1912952284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 N FREEDOM BLVD STE 300",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846011690",
            "telephone_number": "801-373-4760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 N FREEDOM BLVD STE 300",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846011690",
            "telephone_number": "801-373-4760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MESERVY",
        "first_name": "JARLE",
        "middle_name": "ZENOA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "UT",
            "license": "13735041",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "RI",
            "license": "MD09268",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7010556",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "22886-8",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHIP",
            "identifier": "410526",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH",
            "identifier": "15-56484",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.