NPIMap

Individual provider Active NPI

Audrey A Jiricko, MD

  • Obstetrics & Gynecology Physician
  • Ogden, UT
National Provider Identifier
1962510016
Registry record updated Feb 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
5672616-1205 Issued in UT
Practice address
4403 Harrison Blvd
Ste #4815
Ogden, UT 84403-3271
Phone
(801) 387-8350
Fax
(801) 387-8355
NPI assigned
Aug 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 56726168905 UT
Obstetrics & Gynecology Physician 207V00000X 5672616-1205 UT Primary

Addresses

Primary practice location

4403 Harrison Blvd
Ste #4815
Ogden, UT 84403-3271

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 779-6200

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
I20040819001576 UT Practitioner - Obstetrics/Gynecology 0648179218 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Indiana University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

8 TH Ave and C St
Salt Lake City, UT 84143-0001
Phone (801) 408-3446

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5672616-1205UTMDObstetrics & Gynecology Physician
56726168905UTMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc CurrentSince Jul 1, 2004 Accepting new patients
Ihc Health Services, Inc. CurrentSince Jul 1, 2004 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Mount Carmel Health Past Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

201 W Layton Pkwy
Layton, UT 84041
Phone (801) 543-6000

201 W Layton Pkwy
Ste 2C
Layton, UT 84041

2075 University Park Blvd
Layton, UT 84041
Phone (801) 367-2775

4403 Harrison Blvd
Ogden, UT 84403
Phone (801) 387-2800

4403 Harrison Blvd
Ste 4815
Ogden, UT 84403
Phone (801) 387-8350

8th Ave And C St
Salt Lake City, UT 84143
Phone (801) 350-4110

370 Ninth Ave
Ste 205
Salt Lake Cty, UT 84103
Phone (801) 355-9951

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Heber Valley HospitalHeber City, UT, CCN 46Z307 Hospital W-2 Managing Employee Jun 1, 2019
Intermountain Medical Center-RehabilitationMurray, UT, CCN 46T010 Hospital Corporate Officer
W-2 Managing Employee		 Jun 1, 2019
Jun 1, 2019
McKay Dee HospitalOgden, UT, CCN 46T004 Hospital Corporate Officer
W-2 Managing Employee		 Jun 1, 2019
Jun 1, 2019
Logan Regional Hospital Transitional Care UnitLogan, UT, CCN 465123 Skilled nursing facility Corporate Officer
W-2 Managing Employee		 Jun 1, 2019
Jun 1, 2019
Garfield CountyCircleville, UT, CCN 463980 Rural health clinic Corporate Officer Jun 1, 2019

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 2

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": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235001600000",
    "number": "1962510016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-779-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 HARRISON BLVD",
            "address_2": "STE #4815",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844033271",
            "telephone_number": "801-387-8350",
            "fax_number": "801-387-8355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIRICKO",
        "first_name": "AUDREY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-28",
        "last_updated": "2009-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "UT",
            "license": "56726168905",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "UT",
            "license": "5672616-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

Verify at the official NPI Registry.