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MR. JACOB C FETZER PA-C
NPI 1235474172
Physician Assistant in Salt Lake City, UT

Active since December 04, 2012PECOS EnrolledAccepts Medicare Assignment
92.06/100
CMS Quality Rating
30 N 1900 E RM 4A100, SALT LAKE CITY, UT 84132(801) 585-7676 Get Directions Write a Review

NPPES record last updated: November 9, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mr. Jacob C Fetzer Pa-c NPPES

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

MR. JACOB C FETZER PA-C (NPI 1235474172) is an individual physician assistant in Salt Lake City, Utah, licensed in Utah (8421267-1206) and active in the NPI registry since December 2012. He is enrolled in Medicare PECOS, is affiliated with Northeastern Nevada Regional Hospital, and is a graduate of Other (2012).

NPPES Registry Identity

NPI1235474172
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameMR. JACOB C FETZERCredential: PA-C
Location Address30 N 1900 E RM 4A100Salt Lake City, UT 84132-0002
Mailing Address762 E 500 SSalt Lake City, UT 84102-2906 · (801) 574-6455
Phone(801) 585-7676
Sole ProprietorNo
Medical School CMSOtherGraduated 2012
Enumeration DateDecember 4, 2012
Last NPPES UpdateNovember 9, 2021
NPPES CertifiedNovember 9, 2021
✔ NPI 1235474172 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in UT · 8421267-1206
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
30 N 1900 E RM 4A100, Salt Lake City, UT 84132
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Molina Healthcare, Regence BlueCross BlueShield of Utah and more.Insurance ›

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

Mr. Jacob C Fetzer Pa-c 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 ID3678719739
PECOS Enrollment IDI20130415000409
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.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
72 services52 patients
Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or G2212
This service refers to extended doctor visits where your healthcare provider spends additional time evaluating and managing your health beyond the primary procedure's required time. This includes each extra 15 minutes spent by the physician on the same day as the primary service.
65 services46 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
62 services47 patients
Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or G2212
This service refers to extended doctor visits where your healthcare provider spends additional time evaluating and managing your health beyond the primary procedure's required time. This includes each extra 15 minutes spent by the physician on the same day as the primary service.
58 services45 patients

Hospital Affiliations CMS Care Compare 3

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

Northeastern Nevada Regional Hospital

Acute Care Hospitals · Elko, NV
1/5 CMS rating
OwnershipProprietary
CMS Certification Number290008
Location2001 Errecart BlvdElko, NV 89801 · Elko County
Emergency services Birthing friendly

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

Uintah Basin Medical Center

Acute Care Hospitals · Roosevelt, UT
5/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number460019
Location250 West 300 NorthRoosevelt, UT 84066 · Duchesne County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84132 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.41 typical visit price
range $54.34 – $166.03
Typical copayment $21.10 (range $13.58 – $41.50)
Most-billed visit code 99203
Established Patient
$68.01 typical visit price
range $17.23 – $135.20
Typical copayment $17.00 (range $4.30 – $33.80)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

92.06/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality85.57
Promoting Interoperability100
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) A4221
DME-Other DME · category DE017N
2 suppliers46 claims46 services$19.02 avg. paid by Medicare
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) A4222
DME-Medical/Surgical Supplies · category DA000N
2 suppliers55 claims246 services$36.46 avg. paid by Medicare
Injection, milrinone lactate, 5 mg J2260
Treatment-Injections and Infusions (nononcologic) · category RI026N
2 suppliers54 claims2,635 services$1.35 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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.

TAYLOR B. DESMARAIS MD, MS
Internal Medicine (Interventional Cardiology)
30 N 1900 E RM 4A100
SALT LAKE CITY, UT 84132
Salt Lake County (801) 581-2121
DR. ANDREW C. GAGEL MD
Internal Medicine (Cardiovascular Disease)
30 N 1900 E RM 4A100
SALT LAKE CITY, UT 84132
Salt Lake County (801) 587-2451
ALEKSANDRA A. ABRAHAMOWICZ MD
Internal Medicine (Cardiovascular Disease)
30 N 1900 E RM 4A100
SALT LAKE CITY, UT 84132
Salt Lake County (801) 581-2121
CARLOS E. RODRIGUEZ CORREA MD
Internal Medicine (Cardiovascular Disease)
30 N 1900 E RM 4A100
SALT LAKE CITY, UT 84132
Salt Lake County (801) 585-7676
DIANA P. MELO M.D
Internal Medicine (Interventional Cardiology)
30 N 1900 E RM 4A100
SALT LAKE CITY, UT 84132
Salt Lake County (801) 581-2121
DR. NAGESHWARA R. GULLAPALLI MBBS, MPH, MBA
Internal Medicine (Cardiovascular Disease)
30 N 1900 E RM 4A100
SALT LAKE CITY, UT 84132
Salt Lake County (801) 587-2451
KEVIN FELPEL DO
Internal Medicine (Advanced Heart Failure and Transplant Cardiology)
30 N 1900 E RM 4A100
SALT LAKE CITY, UT 84132
Salt Lake County (801) 585-7676
DR. RAVI RANJAN MD
Internal Medicine (Clinical Cardiac Electrophysiology)
30 N 1900 E RM 4A100, HEALTH SCIENCES CENTER
SALT LAKE CITY, UT 84132
Salt Lake County (801) 587-5888

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 Jacob Fetzer's NPI number?

The NPI number for Jacob Fetzer is 1235474172. It was assigned to this individual provider in the NPPES registry on December 4, 2012.

Where is Jacob Fetzer located?

Jacob Fetzer practices at 30 N 1900 E Rm 4a100, Salt Lake City, UT 84132. The listed phone number is (801) 585-7676.

What is Jacob Fetzer's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Jacob Fetzer enrolled in Medicare?

Yes. Jacob Fetzer 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.

What insurance does Jacob Fetzer accept?

Health plans from BridgeSpan Health Company, Molina Healthcare, Regence BlueCross BlueShield of Utah, Select Health and University of Utah Health Plans list Jacob Fetzer as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Jacob Fetzer affiliated with any hospitals?

According to CMS data, Jacob Fetzer is affiliated with Northeastern Nevada Regional Hospital, University Of Utah Hospitals And Clinics and Uintah Basin Medical Center.

When was this NPI record last updated?

The NPPES record for Jacob Fetzer was last updated on November 9, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.