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EJAY JACK LCSW
NPI 1306500590
Social Worker - Clinical in Salt Lake City, UT

Active since October 25, 2021PECOS Enrolled
389 S 900 E, SALT LAKE CITY, UT 84102(385) 282-2500(385) 282-2501 Get Directions Write a Review

NPPES record last updated: October 25, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Ejay Jack Lcsw NPPES

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

EJAY JACK LCSW (NPI 1306500590) is an individual clinical provider in Salt Lake City, Utah, licensed in Utah (12490452-3501) and active in the NPI registry since October 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1306500590
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameEJAY JACKCredential: LCSW
Location Address389 S 900 ESalt Lake City, UT 84102-2310
Mailing Address389 S 900 ESalt Lake City, UT 84102-2310 · (385) 282-2500 · Fax (385) 282-2501
Phone(385) 282-2500
Fax(385) 282-2501
Sole ProprietorNo
Enumeration DateOctober 25, 2021
NPPES CertifiedOctober 25, 2021
✔ NPI 1306500590 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Licenses✔ Licensed in UT · 12490452-3501✔ Licensed in MN · 24475
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
389 S 900 E, Salt Lake City, UT 84102
Open in Google Maps ↗

Other Identifiers 2

Other12490452-3501UT · State Of Utah Division Of Occupational & Professional Licensing, Lcsw License
Other24475MN · State Of Minnesota Board Of Social Work, Licsw License

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Select Health, University of Utah Health Plans.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ejay Jack Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Medicare Billing Reassignment

Medicare enrollment records show Ejay Jack reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Ihc Health Services Inc
Same address
Sports Medicine
389 S 900 E
Salt Lake City, UT 84102
  • Reassigned Medicare billing, Utah enrollment
  • 3,691 clinicians in this Medicare group
NPI 1073808085 (385) 282-2700

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84102 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
$0.00 typical visit price
range $54.34 – $166.03
Typical copayment $0.00 (range $13.58 – $41.50)
Most-billed visit code NA
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.

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.

EMILY DO
Pharmacist
389 S 900 E
SALT LAKE CITY, UT 84102
Salt Lake County (385) 282-2595
RANDY D. RHODES D.P.M.
Podiatrist
389 S 900 E
SALT LAKE CITY, UT 84102
Salt Lake County (385) 282-2000
KELSEY DESALVO
Internal Medicine (Endocrinology, Diabetes & Metabolism)
389 S 900 E
SALT LAKE CITY, UT 84102
Salt Lake County (385) 282-2550
ALISON BATEMAN
Registered Nurse (Diabetes Educator)
389 S 900 E
SALT LAKE CITY, UT 84102
Salt Lake County (385) 282-2550
NIRA LIAT SALANT DPT
Physical Therapist
389 S 900 E
SALT LAKE CITY, UT 84102
Salt Lake County (801) 282-2000
JASON FRANKLIN HAMULA M.D.
Family Medicine
389 S 900 E
SALT LAKE CITY, UT 84102
Salt Lake County (385) 282-2000
STEVEN R. TOWNER M.D.
Internal Medicine
389 S 900 E
SALT LAKE CITY, UT 84102
Salt Lake County (385) 282-2000
DR. THOMAS L LOMBARDI M.D.
Psychiatry & Neurology (Neurology)
389 S 900 E
SALT LAKE CITY, UT 84102
Salt Lake County (385) 282-2000

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 Ejay Jack's NPI number?

The NPI number for Ejay Jack is 1306500590. It was assigned to this individual provider in the NPPES registry on October 25, 2021.

Where is Ejay Jack located?

Ejay Jack practices at 389 S 900 E, Salt Lake City, UT 84102. The listed phone number is (385) 282-2500.

What is Ejay Jack's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Ejay Jack enrolled in Medicare?

Yes. Ejay Jack is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Ejay Jack's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ejay Jack reassigns Medicare benefits to Ihc Health Services Inc (Salt Lake City, UT). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Ejay Jack's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Ejay Jack accept?

Health plans from Select Health and University of Utah Health Plans list Ejay Jack 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.

When was this NPI record last updated?

The NPPES record for Ejay Jack was last updated on October 25, 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.