Individual provider Active NPI

Jason V Church, MD

  • Pediatrics Physician
  • Pleasant View, UT
National Provider Identifier
1992859607
Registry record updated Jan 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
5868694-1205 Issued in UT
Practice address
1100 W 2700 N
Pleasant View, UT 84404-4791
Phone
(801) 475-3600
Fax
(801) 475-3601
NPI assigned
Jan 22, 2007
Last updated
Jan 18, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 5868694-1205 UT Primary

Addresses

Primary practice location

1100 W 2700 N
Pleasant View, UT 84404-4791

Mailing address

PO Box 5546
Denver, CO 80217-5546
Phone (801) 475-3600

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
I20110210000810 UT Practitioner - Pediatric Medicine 4284738386 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ogden Clinic PC Pediatrics CurrentSince Jan 2, 2011 Accepting new patients

Locations

4650 Harrison Blvd
Ogden, UT 84403
Phone (801) 475-3481

5495 S 500 E
Ste 310
Ogden, UT 84405
Phone (801) 475-3100

1100 W 2700 N
Pleasant View, UT 84404
Phone (801) 475-3600

1491 E Ridgeline Dr
South Ogden, UT 84405
Phone (317) 790-7550

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484697600000",
    "number": "1992859607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5546",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802175546",
            "telephone_number": "801-475-3600",
            "fax_number": "801-475-3601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 W 2700 N",
            "city": "PLEASANT VIEW",
            "state": "UT",
            "postal_code": "844044791",
            "telephone_number": "801-475-3600",
            "fax_number": "801-475-3601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "JASON",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2017-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "5868694-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasant View, UT

Sources for this page

Verify at the official NPI Registry.