DR. JARED W HENRICKSEN (NPI# 1396762480) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396762480 |
| Entity Type | Individual |
| Full Name | DR. JARED W HENRICKSEN |
| Credential | MD |
| Practice Address |
100 Mario Capecchi Dr Slc UT 84113-1103 |
| Mailing Address |
295 Chipeta Way Po Box 581289 Slc UT 84108-1287 |
| Practice Telephone | 8016621000 |
| Mailing Telephone | 8015877563 |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2010-01-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
347933-1205 | UT | Allopathic & Osteopathic Physicians |
| Street Address |
100 MARIO CAPECCHI DR |
| City | SLC |
| State | UT |
| Zip Code | 84113-1103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578962007 | Bonnie Larsen | Occupational Therapist | 100 Mario Capecchi Dr, Slc, UT 84113-1103 | 2014-08-20 |
| 1639585011 | Dennis Johnson | Medical Genetics | 100 Mario Capecchi Dr, Dept. of Pathology, Slc, UT 84113-1103 | 2014-07-07 |
| 1083037766 | Lyn Standing | Nurse Practitioner | 100 Mario Capecchi Dr, Slc, UT 84113-1103 | 2014-01-30 |
| 1245671247 | Mary Jo Grant | Nurse Practitioner | 100 Mario Capecchi Dr, Slc, UT 84113-1103 | 2013-07-08 |
| 1487999355 | Tara Lee Finnerty | Dietitian, Registered | 100 Mario Capecchi Dr, Slc, UT 84113-1103 | 2012-12-04 |
| 1740463595 | Tricia Hoggan | Nurse Practitioner | 100 Mario Capecchi Dr, Slc, UT 84113-1103 | 2007-12-14 |
| 1255432001 | John Taylor Smith | Orthopaedic Surgery | 100 Mario Capecchi Dr, 4550, Slc, UT 84113-1103 | 2006-09-26 |
| 1720033079 | Stephanie Marie Holmes | Orthopaedic Surgery | 100 Mario Capecchi Dr, 4550, Slc, UT 84113-1103 | 2006-05-24 |
| 1881649929 | Peter M Stevens | Orthopaedic Surgery | 100 Mario Capecchi Dr, 4550, Slc, UT 84113-1103 | 2006-05-24 |
| 1902859473 | Alan Kendrick Stotts | Orthopaedic Surgery | 100 Mario Capecchi Dr, Slc, UT 84113-1103 | 2006-05-18 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386111060 | Melissa Marie Dixon | Psychologist | Primary Children's Hospital Outpatient Services, 81 South Mario Capecchi Drive, Salt Lake City, UT 84113 | 2018-10-31 |
| 1366965618 | Ashley Stuart | Psychologist | 44 North Mario Capecchi Drive, Salt Lake City, UT 84113 | 2017-07-19 |
| 1487945135 | Justin C Wheeler | Pediatrics | 81 N Mario Capecchi Dr Fl 4, Salt Lake City, UT 84113 | 2011-04-29 |
| 1154612117 | Dana Boucek | Pediatrics | 100 North Mario Capecchi Dr., Primary Children's, Salt Lake City, UT 84113 | 2011-04-26 |
| 1285959502 | Anna Katherine Eyre Ermarth | Pediatrics | 81 Mario Capecchi, Salt Lake City, UT 84113 | 2010-03-30 |
| 1457682072 | Elizabeth K Cho | Nurse Practitioner | 100 North Mario Cappechi Dr., Salt Lake City, UT 84113 | 2010-01-21 |
| 1528290848 | Nancy Crandell Brown | Nurse Practitioner | 100 North Mario Cappechi Drive, Salt Lake City, UT 84113 | 2009-08-20 |
| 1679708481 | Primary Children's Medical Center | General Acute Care Hospital | 100 No. Mario Capecchi Drive, Salt Lake, UT 84113 | 2009-05-22 |
| 1467697235 | Tara Hook | Physical Therapist | 100 North Mario Capecchi Dr, Salt Lake City, UT 84113 | 2008-12-09 |
| 1144474768 | Jennifer K Workman | Pediatrics | 100 N Mario Capecchi Drive, Pediatric Crtical Care, Primary Children's Hospital, Salt Lake City, UT 84113 | 2008-11-10 |
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| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942642541 | Elizabeth Quigley | Pediatrics | 515 E 100 S Ste 200, Salt Lake City, UT 84102-2095 | 2013-07-23 |
| 1144474768 | Jennifer K Workman | Pediatrics | 100 N Mario Capecchi Drive, Pediatric Crtical Care, Primary Children's Hospital, Salt Lake City, UT 84113 | 2008-11-10 |
| 1588634729 | William Bradley Poss | Pediatrics | 295 E Chipeta Way, Salt Lake City, UT 84108-1287 | 2006-01-23 |
| 1174039614 | Ihc Health Services Inc | Pediatrics | 1034 N 500 W, Provo, UT 84604-3380 | 2017-12-20 |
| 1174056758 | Andrew Daniel Fontes | Pediatrics | 295 S Chipeta Way, Salt Lake City, UT 84108-1287 | 2017-04-10 |
| 1457883449 | Lauren Burgunder | Pediatrics | 295 S Chipeta Way, Salt Lake City, UT 84108-1287 | 2017-03-30 |
| 1376907410 | University of Utah Pediatric Acuity Care | Pediatrics | 3741 W 12600 S, Riverton, UT 84065-7215 | 2016-04-05 |
| 1891156741 | University of Utah Pediatric Acuity Care | Pediatrics | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2016-03-18 |
| 1669866133 | Angela Coker | Pediatrics | 295 S Chipeta Way, Salt Lake City, UT 84108 | 2015-03-23 |
| 1801216957 | Kevin Hummel | Pediatrics | 30 N 1900 E # 1c412, Salt Lake City, UT 84132-9760 | 2014-04-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.