NPIMap

Individual provider Active NPI

Bradley F Jenkins, FNP

  • Nurse Practitioner
  • Roosevelt, UT
National Provider Identifier
1912968538
Registry record updated Dec 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
02006314405 Issued in UT
Practice address
210 W 300 N 75-3
Roosevelt, UT 84066
Phone
(435) 722-3971
Fax
(735) 722-6104
NPI assigned
Mar 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 02006314405 UT Primary

Addresses

Primary practice location

210 W 300 N 75-3
Roosevelt, UT 84066

Mailing address

210 W 300 N 75-3
Roosevelt, UT 84066
Phone (435) 722-3971

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
I20040323000715 UT Practitioner - Nurse Practitioner 3971494535 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Uintah Basin Medical Center 62 clinicians
Northeastern Utah Medical Group 52 clinicians

Practice addresses (Care Compare)

210 W 300
Roosevelt, UT 84066-2336

250 W 300
Roosevelt, UT 84066-2336

Hospital & facility affiliations

  • Canyon Home Care Home health agency, Murray, UT, CCN 467226
  • Uintah Basin Medical Center Hospital, Roosevelt, UT, CCN 460019

Merit-based Incentive Payment System (MIPS)

Final score
89.32 of 100Reported as apm
Quality
71.89
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
02006314405UTMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Utah Medical Group Family Medicine CurrentSince Jul 1, 2002 Accepting new patients
Northeastern Utah Medical Group CurrentSince Jul 1, 2002 Accepting new patients

Locations

50 E 200 S
Duchesne, UT 84021
Phone (435) 738-2426

210 W 300 N
Roosevelt, UT 84066
Phone (435) 722-4691

210 W 300 N
#753
Roosevelt, UT 84066
Phone (435) 722-3971

250 W 300 N
#752
Roosevelt, UT 84066
Phone (435) 722-4691

210 W 300 N
Ste 753
Roosevelt, UT 84066

250 W 300 N
Roosevelt, UT 84066
Phone (435) 722-4691

405 N 500 W
Vernal, UT 84078
Phone (435) 781-2335

475 N 500 W
Vernal, UT 84078
Phone (435) 781-2030

Organizations & group practices 11

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 4

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": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196899200000",
    "number": "1912968538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 W 300 N 75-3",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "84066",
            "telephone_number": "435-722-3971",
            "fax_number": "735-722-6104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W 300 N 75-3",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "84066",
            "telephone_number": "435-722-3971",
            "fax_number": "735-722-6104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENKINS",
        "first_name": "BRADLEY",
        "middle_name": "F",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2007-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "02006314405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roosevelt, UT

Sources for this page

Verify at the official NPI Registry.