Jacob Stout

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

13593511-1206 Issued in UT

Practice address

2472 S 300 E
South Salt Lake, UT 84115-2895

Phone

(801) 783-5011

NPI assigned

Aug 1, 2022

Last updated

Nov 1, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Santibanez Pac UtahGroup PAC ID 1355785437, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Santibanez Pac Utah

  • Geriatric Medicine (Internal Medicine) Physician
  • Salt Lake City, UT
  • NPI 1881469484
  Medicare reassignment Care Compare group
• Utah Regional Hospitalists LLC

  • Hospitalist Physician
  • Murray, UT
  • NPI 1962821223
  Medicare reassignment NPD
• Post Acute Medical PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Lanham, MD
  • NPI 1730713025

  UT

  Medicare reassignment

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

{
    "created_epoch": "1659312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1952037939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 MOYLE DR",
            "city": "ALPINE",
            "state": "UT",
            "postal_code": "840041200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2472 S 300 E",
            "city": "SOUTH SALT LAKE",
            "state": "UT",
            "postal_code": "841152895",
            "telephone_number": "801-783-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOUT",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-01",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "13593511-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Stenquist, MS CCC-SLP
• Ysabelle Stepp
• Jonathan Michael Stiles, LICSW, LCSW
• Allyson B Stockdale
• Tyler Storey
• Sarah Strang, SSW
• Genevieve Dian Strattman, LCSW
• Micah Stratton
• Sunrise Acupuncture Clinic
• Sunshine Behavioral Health LLC

• Physician Assistant in South Salt Lake, UT
• Providers in South Salt Lake, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; 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.

Verify at the official NPI Registry.