David B Jack
MOUNTAINSTAR MEDICAL GROUP-ST. MARKS HOSPITAL LLC


Address: 74 E Kimballs Ln, Draper, UT 84020-5009

David B Jack (NPI# 1255434296, PAC ID# 5193790079) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.

Physician Overview

Nation Provider ID (NPI) 1255434296
PAC ID by PECOS 5193790079
Professional Enrollment ID I20040907001148
Full Name David B Jack
Organization Legal Name MOUNTAINSTAR MEDICAL GROUP-ST. MARKS HOSPITAL LLC
Address 74 E Kimballs Ln
Draper
UT 84020-5009
Gender M
Credential MD
Medical School UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES
Graduation Year 1981
Primary Specialty FAMILY MEDICINE
Secondary Specialties INTERNAL MEDICINE
Group Practice PAC ID 1557443322
Number of Group Practice Members 21
Accepts Medicare Assignment Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
460060 LONE PEAK HOSPITAL
460047 ST MARK'S HOSPITAL
460010 INTERMOUNTAIN MEDICAL CENTER

Other Locations

Address Phone Organization
74 E Kimballs Ln, Draper, UT 84020-5009 MOUNTAINSTAR MEDICAL GROUP-ST. MARKS HOSPITAL LLC
4465 S 900 E, Suite 200, Salt Lake City, UT 84124-2456 8012662777 MOUNTAINSTAR MEDICAL GROUP-ST. MARKS HOSPITAL LLC

Individual EP (Eligible Professionals) Public Reporting – Performance Scores
Physician Quality Reporting System (PQRS) and non-PQRS Qualified Clinical Data Registry (QCDR)

Measure Identifier Measure Title Performance Rate Reporting Mechanism
ACI_EC_TRANS_PHCDRR_1 Immunization Registry Reporting %
ACI_EC_TRANS_PHCDRR_3 Specialized Registry Reporting %
ACI_EC_TRANS_PPHI_1 Security Risk Analysis %

Organization Information

Organization Legal Name MOUNTAINSTAR MEDICAL GROUP-ST. MARKS HOSPITAL LLC
Physicians 21

Physicians with the same organization

Name Specialty Organization Address
Todd W. Furness Family Medicine Mountainstar Medical Group-st. Marks Hospital LLC 11760 S 700 E, Suite 111, Draper, UT 84020-6605
Todd N Schauers Physician Assistant Mountainstar Medical Group-st. Marks Hospital LLC 4465 S 900 E, Suite 200, Salt Lake City, UT 84124-2456
Philip Leonard Roberts Internal Medicine Mountainstar Medical Group-st. Marks Hospital LLC 74 E Kimballs Ln, Suite 300, Draper, UT 84020-5009
Daniel Trevor Young Family Medicine Mountainstar Medical Group-st. Marks Hospital LLC 74 E Kimballs Ln, Suite 300, Draper, UT 84020-5009
Amelia Maass Nurse Practitioner Mountainstar Medical Group-st. Marks Hospital LLC 4465 S 900 E, Suite 200, Salt Lake City, UT 84124-2456
Andrew Robinson Family Medicine Mountainstar Medical Group-st. Marks Hospital LLC 74 E Kimballs Ln, Draper, UT 84020-5009
Matthew M Schellenberg Family Medicine Mountainstar Medical Group-st. Marks Hospital LLC 74 E Kimballs Ln, Draper, UT 84020-5009
Richard Wayne Bennett Internal Medicine Mountainstar Medical Group-st. Marks Hospital LLC 74 E Kimballs Ln, Draper, UT 84020-5009
Joni W Hougaard Family Medicine Mountainstar Medical Group-st. Marks Hospital LLC 4465 S 900 E, Suite 200, Salt Lake City, UT 84124-2456
Evan Reinhardt Family Medicine Mountainstar Medical Group-st. Marks Hospital LLC 8846 S Redwood Rd, 121 Jordan Family Health, West Jordan, UT 84088-9334

Office Location

Street Address 74 E KIMBALLS LN
City DRAPER
State UT
Zip 84020-5009

Physicians in the same location

Name Specialty Organization Address
James S Zebrack Cardiovascular Disease (cardiology) Mountainstar Cardiology St Marks LLC 74 E Kimballs Ln, Suite 260, Draper, UT 84020-5009
Scott E Bruderer Physician Assistant Mountainstar Specialty Services LLC 74 E Kimballs Ln, Suite 330, Draper, UT 84020-5006
Philip Leonard Roberts Internal Medicine Mountainstar Medical Group-st. Marks Hospital LLC 74 E Kimballs Ln, Suite 300, Draper, UT 84020-5009
Kenneth G Nielson Cardiovascular Disease (cardiology) Mountainstar Cardiology St Marks LLC 74 E Kimballs Ln, Suite 260, Draper, UT 84020-5009
Larry E Urry Dermatology 74 E Kimballs Ln, Suite 230, Draper, UT 84020-5005
Daniel Trevor Young Family Medicine Mountainstar Medical Group-st. Marks Hospital LLC 74 E Kimballs Ln, Suite 300, Draper, UT 84020-5009
Traske M Muir Orthopedic Surgery Mountainstar Specialty Services LLC 74 E Kimballs Ln, Suite 330, Draper, UT 84020-5006
Vamsee M Yaganti Interventional Cardiology Mountainstar Cardiology St Marks LLC 74 E Kimballs Ln, Suite 260, Draper, UT 84020-5009
Andrew Charles Behunin Internal Medicine Mountainstar Cardiology St Marks LLC 74 E Kimballs Ln, Suite 260, Draper, UT 84020-5009
Andrew Robinson Family Medicine Mountainstar Medical Group-st. Marks Hospital LLC 74 E Kimballs Ln, Draper, UT 84020-5009
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Physicians in the same zip code

Name Specialty Organization Address
Mark Christensen Emergency Medicine Emergency Physicians Integrated Care LLC 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001
Matthew Broadwater-hollifield Emergency Medicine Emergency Physicians Integrated Care LLC 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001
Azher M Merchant Emergency Medicine Emergency Physicians Integrated Care LLC 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001
Jeffrey L Hardin Emergency Medicine Emergency Physicians Integrated Care LLC 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001
Laurie C Raborn Emergency Medicine Emergency Physicians Integrated Care LLC 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001
Jinghui Li Emergency Medicine Emergency Physicians Integrated Care LLC 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001
Charles David Eller Emergency Medicine Emergency Physicians Integrated Care LLC 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001
Jeremy Voros Emergency Medicine Emergency Physicians Integrated Care LLC 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001
Jennifer F Robison Psychologist, Clinical 12481 S Fort St, Suite 275, Draper, UT 84020-2106
Matthew D Smith Chiropractic Elite Performance Health Center PC 13552 S 110 W, Suite 204, Draper, UT 84020-2403
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Competitor

Search similar physicians

City DRAPER
Zip Code 84020
Specialty FAMILY MEDICINE
City + Specialty DRAPER + FAMILY MEDICINE

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS)
Jurisdiction Medicare

This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.

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