Benjamin Clark Jacobs, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

9693882-1205 Issued in UT

Practice address

1055 N 500 W
Ste 112
Provo, UT 84604-3305

Phone

(801) 812-4624

Fax

(801) 812-4699

NPI assigned

Apr 2, 2009

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

Electronic endpoints 1

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

Specialty

Diagnostic Radiology

Education

Washington University School of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Revere Health PCGroup PAC ID 7517868508, 407 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Timpanogos Regional Hospital Hospital, Orem, UT, CCN 460052
• Holy Cross Hospital-Jordan Valley Hospital, West Jordan, UT, CCN 460051
• Central Valley Medical Center - Cah Hospital, Nephi, UT, CCN 461304
• Mountain View Hospital Hospital, Payson, UT, CCN 460013

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Revere Health PC

  • Multi-Specialty Clinic/Center
  • Provo, UT
  • NPI 1093764805
  Medicare reassignment Care Compare group NPD
• Revere Health PC

  • Multi-Specialty Clinic/Center
  • Spanish Fork, UT
  • NPI 1851142285
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Catholic Health Initiatives Colorado

  • General Acute Care Hospital
  • West Jordan, UT
  • NPI 1801591391
  Care Compare affiliation
• Central Valley Medical Center

  • Critical Access Hospital
  • Nephi, UT
  • NPI 1881658110
  Care Compare affiliation
• Central Valley Medical Center

  • Family Medicine Physician
  • Nephi, UT
  • NPI 1992724975

  Hospital

  Care Compare affiliation
• Mountain View Hospital, Inc.

  • General Acute Care Hospital
  • Payson, UT
  • NPI 1487607669
  Care Compare affiliation
• Timpanogos Regional Medical Services, Inc.

  • General Acute Care Hospital
  • Orem, UT
  • NPI 1497702195
  Care Compare affiliation

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

{
    "created_epoch": "1238630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742860800000",
    "number": "1982846119",
    "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": "846043305",
            "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": "1055 N 500 W",
            "address_2": "STE 112",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-812-4624",
            "fax_number": "801-812-4699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "BENJAMIN",
        "middle_name": "CLARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-02",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "9693882-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Central Utah Clinic, P.C.",
            "address_1": "1055 N 500 W",
            "address_2": "Ste 112",
            "city": "Provo",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846043305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stephanie Andreya Jackson, RDH
• Adrianne Shumway Jacob
• Alan R Jacob, L.P.C.
• Anna Jacob
• Scott R. Jacob, M.D.
• Michael Jacobs
• Sarah Jacobs
• Zion Zao Jacobs
• Zoe Reese Jacobs
• Lauren Elizabeth Jacobsen

• Diagnostic Radiology Physician in Provo, UT
• Providers in Provo, UT by specialty
• Diagnostic Radiology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2025; 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.