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KATRIEN JACK PA-C
NPI 1366024390
Physician Assistant in Roy, UT

Active since April 28, 2021PECOS EnrolledAccepts Medicare Assignment
92.06/100
CMS Quality Rating

NPPES record last updated: November 21, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 21, 2025, Mar 11, 2025, Dec 11, 2022 and 2 more (5 updates tracked since 2021).

About Katrien Jack Pa-c NPPES

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

KATRIEN JACK PA-C (NPI 1366024390) is an individual physician assistant in Roy, Utah, licensed in Utah (13028685-1206) and active in the NPI registry since April 2021. She is enrolled in Medicare PECOS, is affiliated with Mckay-dee Hospital, and maintains a secondary practice location in Kaysville.

NPPES Registry Identity

NPI1366024390
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameKATRIEN JACKCredential: PA-C
Location Address1915 W 5950 SRoy, UT 84067-1454
Mailing AddressPo Box 27128Salt Lake City, UT 84127-0128
Phone(801) 387-8100
Sole ProprietorNo
Medical School CMSUniversity Of Utah School Of MedicineGraduated 2022
Enumeration DateApril 28, 2021
Last NPPES UpdateNovember 21, 20255 updates tracked since enumeration
NPPES CertifiedNovember 21, 2025
✔ NPI 1366024390 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 · 13028685-1206
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.
1915 W 5950 S, Roy, UT 84067
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Secondary Practice Location 1

Location 11351 W 200 NKaysville, UT 84037 · Phone (801) 383-3420 · Fax (801) 383-3421

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Regence BlueCross BlueShield of Utah, Select Health 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

Katrien Jack 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 ID7012386212
PECOS Enrollment IDI20221209002387
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 5

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 moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
127 services62 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.
58 services46 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
28 services28 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
23 services21 patients
New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205
This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
11 services11 patients

Hospital Affiliations CMS Care Compare 2

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

Mckay-Dee Hospital

Acute Care Hospitals · Ogden, UT
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number460004
Location4401 Harrison BoulevardOgden, UT 84403 · Weber County
Emergency services Birthing friendly

Intermountain Health Layton Hospital

Acute Care Hospitals · Layton, UT
OwnershipVoluntary non-profit - Private
CMS Certification Number460061
Location201 West Layton ParkwayLayton, UT 84041 · Davis County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84067 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

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.

KURTIS DON ELLIS M.D.
Family Medicine
1915 W 5950 S
ROY, UT 84067
Weber County (801) 387-8100
IHC HEALTH SERVICES INC
Family Medicine
1915 W 5950 S
ROY, UT 84067
Weber County (801) 387-8100
JARED DON HIATT DO
Family Medicine
1915 W 5950 S
ROY, UT 84067
Weber County (801) 387-8100
DR. BRENT E WALLACE MD
Family Medicine
1915 W 5950 S
ROY, UT 84067
Weber County (801) 387-8100
RICHARD R RUSSELL PA
Physician Assistant
1915 W 5950 S
ROY, UT 84067
Weber County (801) 387-8100
DR. JOHN R WOOD MD
Family Medicine
1915 W 5950 S
ROY, UT 84067
Weber County (801) 387-8100
NICHOLAS JAMES BIGGS PA-C
Physician Assistant
1915 W 5950 S
ROY, UT 84067
Weber County (801) 387-8100
IHC HEALTH SERVICES INC
Pharmacy (Community/Retail Pharmacy)
1915 W 5950 S
ROY, UT 84067
Weber County (801) 387-8215

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 Katrien Jack's NPI number?

The NPI number for Katrien Jack is 1366024390. It was assigned to this individual provider in the NPPES registry on April 28, 2021.

Where is Katrien Jack located?

Katrien Jack practices at 1915 W 5950 S, Roy, UT 84067. The listed phone number is (801) 387-8100.

What is Katrien Jack's specialty?

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

Is Katrien Jack enrolled in Medicare?

Yes. Katrien Jack 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 Katrien Jack accept?

Health plans from BridgeSpan Health Company, Regence BlueCross BlueShield of Utah, Select Health and University of Utah Health Plans list Katrien 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.

Is Katrien Jack affiliated with any hospitals?

According to CMS data, Katrien Jack is affiliated with Mckay-Dee Hospital and Intermountain Health Layton Hospital.

When was this NPI record last updated?

The NPPES record for Katrien Jack was last updated on November 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.