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JACK A. DUBUQUE MD
NPI 1104403526
Anesthesiology in Salt Lake City, UT

Active since March 24, 2021PECOS EnrolledAccepts Medicare Assignment
30 N 1900 E RM 3C444, SALT LAKE CITY, UT 84132(801) 581-3622 Get Directions Write a Review

NPPES record last updated: December 29, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 29, 2025, Aug 10, 2022, Mar 24, 2021 (3 updates tracked since 2021).

About Jack A. Dubuque Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACK A. DUBUQUE MD (NPI 1104403526) is an individual anesthesiology provider in Salt Lake City, Utah, licensed in Utah (12974673-1205) and active in the NPI registry since March 2021. He is enrolled in Medicare PECOS, is affiliated with University Of Utah Hospitals And Clinics, and is a graduate of University Of Vermont College Of Medicine (2021).

NPPES Registry Identity

NPI1104403526
Entity TypeIndividualMale
Primary Taxonomy207L00000X
Provider Legal NameJACK A. DUBUQUECredential: MD
Location Address30 N 1900 E RM 3C444Salt Lake City, UT 84132-2095
Mailing Address30 N 1900 E Rm 3c444Salt Lake City, UT 84132-2095 · (801) 581-3622
Phone(801) 581-3622
Sole ProprietorNo
Medical School CMSUniversity Of Vermont College Of MedicineGraduated 2021
Enumeration DateMarch 24, 2021
Last NPPES UpdateDecember 29, 20253 updates tracked since enumeration
NPPES CertifiedDecember 29, 2025
✔ NPI 1104403526 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAnesthesiologyAllopathic & Osteopathic Physicians
Taxonomy Code207L00000X
License✔ Licensed in UT · 12974673-1205
Definition
An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation or an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during and after surgery. In addition to these management responsibilities, the anesthesiologist provides medical management and consultation in pain management and critical care medicine. Anesthesiologists diagnose and treat acute, long-standing and cancer pain problems; diagnose and treat patients with critical illnesses or severe injuries; direct resuscitation in the care of patients with cardiac or respiratory emergencies, including the need for artificial ventilation; and supervise post-anesthesia recovery.
30 N 1900 E RM 3C444, Salt Lake City, UT 84132
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jack A. Dubuque Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2062896020
PECOS Enrollment IDI20250715002332
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

University Of Utah Hospitals And Clinics

Acute Care Hospitals · Salt Lake City, UT
5/5 CMS rating
OwnershipGovernment - State
CMS Certification Number460009
Location50 North Medical DriveSalt Lake City, UT 84132 · Salt Lake County
Emergency services Birthing friendly

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AARON SMITH MD
Anesthesiology
30 N 1900 E RM 3C444
SALT LAKE CITY, UT 84132
Salt Lake County (801) 581-3622
DR. KATHERINE LEIGH KONIUCH M.D.
Anesthesiology
30 N 1900 E RM 3C444
SALT LAKE CITY, UT 84132
Salt Lake County (801) 581-6393
RYAN C. GRAHAM MD
Anesthesiology
30 N 1900 E RM 3C444
SALT LAKE CITY, UT 84132
Salt Lake County (801) 581-3622
TRACY WANXI LIAN MD
Anesthesiology
30 N 1900 E RM 3C444
SALT LAKE CITY, UT 84132
Salt Lake County (801) 581-6393
AARON J. ROSENBAUM MD
Anesthesiology
30 N 1900 E RM 3C444
SALT LAKE CITY, UT 84132
Salt Lake County (801) 581-3622
ZACHARY A. LEE M.D.
Anesthesiology
30 N 1900 E RM 3C444
SALT LAKE CITY, UT 84132
Salt Lake County (801) 587-1771
SIERRA A. MASTRANTONIO MD
Anesthesiology
30 N 1900 E RM 3C444
SALT LAKE CITY, UT 84132
Salt Lake County (801) 581-3622
LINNEA E. DIXSON MD
Anesthesiology
30 N 1900 E RM 3C444
SALT LAKE CITY, UT 84132
Salt Lake County (801) 581-6393

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Dubuque's NPI number?

The NPI number for Jack Dubuque is 1104403526. It was assigned to this individual provider in the NPPES registry on March 24, 2021.

Where is Jack Dubuque located?

Jack Dubuque practices at 30 N 1900 E Rm 3c444, Salt Lake City, UT 84132. The listed phone number is (801) 581-3622.

What is Jack Dubuque's specialty?

The primary specialty registered for this NPI is Anesthesiology with taxonomy code 207L00000X.

Is Jack Dubuque enrolled in Medicare?

Yes. Jack Dubuque is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Jack Dubuque affiliated with any hospitals?

According to CMS data, Jack Dubuque is affiliated with University Of Utah Hospitals And Clinics.

When was this NPI record last updated?

The NPPES record for Jack Dubuque was last updated on December 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.