JERRY JOHN (NPI# 1659440543) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659440543 |
| Entity Type | Individual |
| Full Name | JERRY JOHN |
| Credential | MD |
| Practice Address |
4403 Harrison Blvd Suite 3450 Ogden UT 84403-3271 |
| Mailing Address |
Po Box 27128 Salt Lake City UT 84127-0128 |
| Practice Telephone | 8013873850 |
| Mailing Telephone | 8013873850 |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2010-11-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 200501438 | NC | Allopathic & Osteopathic Physicians |
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
5210479-1205 | UT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | PARTNERS MEDICARE | 807070 | 01 |
| NC | BCBS OF NC | 140XV | 01 |
| NC | MEDCOST | 183494 | 01 |
| UT | 1659440543 | 05 | |
| NC | 5902155 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053920504 | Jerry Varghese Thuthikattu John | Family Medicine | 2400 W Villard Ave, Milwaukee, WI 53209-4901 | 2020-07-29 |
| Street Address |
4403 HARRISON BLVD SUITE 3450 |
| City | OGDEN |
| State | UT |
| Zip Code | 84403-3271 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518962794 | Fred George Seale Iv | Obstetrics & Gynecology | 4403 Harrison Blvd, Ste 4650, Ogden, UT 84403-3271 | 2005-06-15 |
| 1720502859 | Derek Smith | Physician Assistant | 4403 Harrison Blvd, Ogden, UT 84403-3271 | 2017-07-31 |
| 1245766393 | Jacob Saunders | Student in an Organized Health Care Education/Training Program | 4403 Harrison Blvd, Suite A-700, Ogden, UT 84403-3271 | 2017-05-11 |
| 1043746191 | Haleigh Emerson | Family Medicine | 4403 Harrison Blvd, Suite A700, Ogden, UT 84403-3271 | 2017-05-11 |
| 1457887507 | Madison Beatty | Student in an Organized Health Care Education/Training Program | 4403 Harrison Blvd, Suite A700, Ogden, UT 84403 | 2017-05-11 |
| 1669908711 | Spencer Ruben | Student in an Organized Health Care Education/Training Program | 4403 Harrison Blvd, Suite A700, Ogden, UT 84403-3271 | 2017-05-11 |
| 1376083147 | Linda Maria Jones | Nurse Practitioner | 4403 Harrison Blvd, Suite 3490, Ogden, UT 84403 | 2017-02-27 |
| 1114376431 | Jonas Legrand Peterson | Family Medicine | 4403 Harrison Blvd, Suite A-700, Ogden, UT 84403-3271 | 2016-06-07 |
| 1649629965 | Derek Paul Wille | Family Medicine | 4403 Harrison Blvd, Suite A-700, Ogden, UT 84403-3271 | 2016-06-07 |
| 1467838086 | Brandy Millward | Social Worker | 4403 Harrison Blvd, Suite 3630, Ogden, UT 84403-3271 | 2015-08-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235744632 | Megan Louise Larkins | Specialist/Technologist | 4000 Brinker Ave. The Apartments., Apartment 15, Ogden, UT 84403 | 2020-09-11 |
| 1154959062 | Joshua Clifford Hansen | Student in an Organized Health Care Education/Training Program | 4403 Harrison Boulevard, Ste A700, Ogden, UT 84403 | 2020-03-28 |
| 1346895935 | Positional Release Therapy Institute LLC | Specialist/Technologist | 1702 E. 5600 S., Ogden, UT 84403 | 2019-08-09 |
| 1841842077 | Braken Wooden | Chiropractor | 1893 Skyline Dr., Suite 204, South Ogden, UT 84403 | 2019-07-09 |
| 1023670569 | Wasatch Advanced Dental Care LLC | Dentist | 3590 Harrison Blvd Suite #1, Ogden, UT 84403 | 2019-07-05 |
| 1194237636 | Marci Niemeyer | Physician Assistant | 5929 Fashion Point Dr Ste 101, South Ogden, UT 84403 | 2017-10-24 |
| 1578081949 | Stephanie Jensen | Specialist/Technologist | 1473 36th Street, Ogden, UT 84403 | 2017-09-06 |
| 1891213385 | Forrest Sutherland | Specialist/Technologist | 1075 E 41st St., Ogden, UT 84403 | 2017-09-05 |
| 1184159022 | Nicole Lee Van Tassell | In Home Supportive Care | 1496 East 5600 South, Unit 6, Ogden, UT 84403 | 2017-04-28 |
| 1265889166 | Modern Dental Professionals Ut, PC | Dentist | 5974 S. Fashion Pointe Drive, Suite 210, South Ogden, UT 84403 | 2016-05-20 |
| Find all providers in zip 84403 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427233402 | Richard White | Internal Medicine | 5028 Skyline Dr, Ogden, UT 84403-1423 | 2008-01-08 |
| 1427237007 | Saima Husain | Internal Medicine | 4403 Harrison Blvd Ste 3430, Ogden, UT 84403 | 2007-10-30 |
| 1114969433 | Ishtiaque Hossain Mohiuddin | Internal Medicine | 5405 S 500 E Ste 204, Ogden, UT 84405-7420 | 2006-06-12 |
| 1326043472 | Dan Dan | Internal Medicine | 4403 Harrison Blvd Ste 3450, Ogden, UT 84403 | 2005-06-16 |
| 1992196968 | Ihc Health Services Inc | Internal Medicine | 4403 Harrison Blvd, Ste 3430, Ogden, UT 84403-3271 | 2015-02-12 |
| 1174829139 | Ihc Health Services Inc | Internal Medicine | 4403 Harrison Blvd, Ste 3400, Ogden, UT 84403-3281 | 2011-02-08 |
| 1457662587 | Ihc Health Services Inc | Internal Medicine | 4403 Harrison Blvd Ste 3450, Ogden, UT 84403-3282 | 2010-06-23 |
| 1598994659 | Shyla Narasimhan Sachdev | Internal Medicine | 5405 S 500 E Ste 204, Ogden, UT 84405 | 2009-07-10 |
| 1982844098 | Peter George Forstall | Internal Medicine | 5405 S 500 E, Suite 204, Ogden, UT 84405-6957 | 2009-03-02 |
| 1700099983 | Yuri Khodakov | Internal Medicine | 4403 Harrison Blvd, Suite 3490, Ogden, UT 84403-3271 | 2007-05-07 |
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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.