Jason V Church, MD
Individual provider Active NPI Pediatrics Physician · Pleasant View, UT
NPI 1992859607 · NPPES record last updated Jan 18, 2017
Key facts
- NPI
- 1992859607
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 5868694-1205 (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
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110210000810 | UT | Practitioner - Pediatric Medicine | 4284738386 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5868694-1205 | UT | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ogden Clinic PC | Pediatrics | Current |
Accepting new patients |
Locations
5495 S 500 E
Ste 310
Ogden, UT 84405
Phone (801) 475-3100
4650 Harrison Blvd
Ogden, UT 84403
Phone (801) 475-3481
1100 W 2700 N
Pleasant View, UT 84404
Phone (801) 475-3600
1491 E Ridgeline Dr
South Ogden, UT 84405
Phone (317) 790-7550
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 5868694-1205 | UT | Yes |
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
Other providers in Pleasant View, UT
- Choice Counseling & Consulting
- Choice Supported Employment Services Inc
- Jordan Miles Christensen
- Travis Clyde Christensen
- Van G Christiansen
- Close to You
- Columbia Ogden Medical Center, Inc.
- Mitchell Wasden Cooney
- Patrick K Cox
- Scott Hinckley Craven
All providers in Pleasant View, UT · Pediatrics Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.