Active NPI
Colton Jackson, NP
- Family Nurse Practitioner
- Salem, UT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 9420231-4405
- Practice address
- 555 W State Road 164
Salem, UT 84653-5732 - Phone
- (385) 203-2720
- Fax
- (801) 798-8961
- NPI assigned
- Oct 4, 2024
- Last updated
- Oct 4, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 9420231-4405 | UT | Primary |
Addresses
Primary practice location
555 W State Road 164
Salem, UT 84653-5732
Mailing address
1055 N 500 W
Attn: Credentialing
Provo, UT 84604
Phone (801) 354-8225
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
555 W Sr
Suite 164
Salem, UT 84653
Phone (801) 465-4813
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revere Health PC | Current | Accepting new patients | |
| Revere Health PC | Current | Accepting new patients |
Locations
4095 E Pony Express Pkwy
Ste 1
Eagle Mountain, UT 84005
Phone (801) 429-8037
1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000
1055 N 500 W
Ste 212
Provo, UT 84604
Phone (801) 374-2362
555 W State Road 164
Salem, UT 84653
Phone (801) 465-4896
Interoperability endpoints
- coltonjackson@cuccu.allscriptsdirect.net
Organizations & group practices 2
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.
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Nephi, UT
- NPI 1881658110
-
dba Nephi Medical Clinic
- Family Medicine Physician
- Nephi, UT
- NPI 1992724975
Hospital
-
dba Intermountain Health Utah Valley Hospital
- General Acute Care Hospital
- Provo, UT
- NPI 1114025491
-
dba Intermountain Health Sanpete Valley Hospital
- Critical Access Hospital
- Mt Pleasant, UT
- NPI 1407964398
-
dba Intermountain Health Infusion Center- Spanish Fork, A Service of Utah Valley Hospital
- Infusion Therapy Clinic/Center
- Spanish Fork, UT
- NPI 1679426944
Hospital
-
dba Intermountain Health American Fork Hospital
- General Acute Care Hospital
- American Fork, UT
- NPI 1912014358
-
dba Intermountain Health Infusion Center- American Fork, A Service of Utah Valley Hospital
- Infusion Therapy Clinic/Center
- American Fork, UT
- NPI 1982557252
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728000000000",
"number": "1942029152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 N 500 W",
"address_2": "ATTN: CREDENTIALING",
"city": "PROVO",
"state": "UT",
"postal_code": "84604",
"telephone_number": "801-354-8225",
"fax_number": "801-418-0941"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 W STATE ROAD 164",
"city": "SALEM",
"state": "UT",
"postal_code": "846535732",
"telephone_number": "385-203-2720",
"fax_number": "801-798-8961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "COLTON",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-10-04",
"last_updated": "2024-10-04",
"certification_date": "2024-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "UT",
"license": "9420231-4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.