Individual provider Active NPI

Jordan L. Bormann, MD

  • Dermatology Physician
  • Salt Lake City, UT
National Provider Identifier
1952925455
Registry record updated Dec 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
12974631-1205 Issued in UT
Practice address
30 N 1900 E RM 4A330
Salt Lake City, UT 84132-0002
Phone
(801) 581-6465
NPI assigned
Jun 1, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 12974631-1205 UT Primary

Addresses

Primary practice location

30 N 1900 E RM 4A330
Salt Lake City, UT 84132-0002

Mailing address

30 N 1900 E RM 4A330
Salt Lake City, UT 84132-0002
Phone (801) 581-6465

Other practice location 1

1400 W 22nd St
Sioux Falls, SD 57105-1554
Phone (605) 505-0515

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jbormann580156@direct.med.utah.edu Direct University of Utah

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250912004042 UT Practitioner - Dermatology 6709280886 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Sanford School of Medicine of University of South Dakota, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dermatology Division University of Utah Medical CenterGroup PAC ID 9638073497, 73 clinicians

Practice addresses (Care Compare)

50 N Medical Dr
Salt Lake City, UT 84132-0001
Phone (801) 587-6340

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions111
Removal or shaving of skin growth1-10
Skin biopsy80

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12974631-1205UTMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatology Division University of Utah Medical Center Dermatology CurrentSince Aug 1, 2025 Accepting new patients
U-U Pediatric Dermatology PastSince May 24, 2020 Accepting new patients

Locations

243 E 6100 S
Salt Lake City, UT 84107
Phone (801) 581-6465

168 N 1950 W
Salt Lake City, UT 84116
Phone (801) 587-6453

50 N Medical Dr
#E13
Salt Lake City, UT 84132

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

1280 E Stringham Ave
Slc, UT 84106
Phone (801) 213-9077

Interoperability endpoints

  • Direct secure messaging: jbormann580156@direct.med.utah.edu

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1590969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766966400000",
    "number": "1952925455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N 1900 E RM 4A330",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320002",
            "telephone_number": "801-581-6465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N 1900 E RM 4A330",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320002",
            "telephone_number": "801-581-6465"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 W 22nd St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571051554",
            "country_code": "US",
            "telephone_number": "605-505-0515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BORMANN",
        "first_name": "JORDAN",
        "middle_name": "L.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-01",
        "last_updated": "2025-12-29",
        "certification_date": "2025-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "UT",
            "license": "12974631-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jbormann580156@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.