MR. JEDEDIAH DOUGLAS KOWALSKI APRN
NPI 1366963928
Nurse Practitioner - Family in South Jordan, UT

Active since July 03, 2017PECOS EnrolledAccepts Medicare Assignment
95.7/100
CMS Quality Rating
5126 W DAYBREAK PKWY, SOUTH JORDAN, UT 84009(801) 656-7647 Get Directions Write a Review

NPPES record last updated: November 17, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Nov 17, 2021, Jul 3, 2017 (2 updates tracked since 2017).

About Mr. Jedediah Douglas Kowalski Aprn NPPES

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

MR. JEDEDIAH DOUGLAS KOWALSKI APRN (NPI 1366963928) is an individual family provider in South Jordan, Utah, licensed in Utah (7964951-4405) and active in the NPI registry since July 2017. He is enrolled in Medicare PECOS, is affiliated with University Of Utah Hospitals And Clinics, and is a graduate of Other (2017).

NPPES Registry Identity

NPI1366963928
Entity TypeIndividualMale
Primary Taxonomy363LF0000X
Provider Legal NameMR. JEDEDIAH DOUGLAS KOWALSKICredential: APRN
Location Address5126 W DAYBREAK PKWYSouth Jordan, UT 84009-5994
Mailing Address856 W Rontano CtMidvale, UT 84047-1605
Sole ProprietorYes
Medical School CMSOtherGraduated 2017
Enumeration DateJuly 3, 2017
Last NPPES UpdateNovember 17, 20212 updates tracked since enumeration
NPPES CertifiedNovember 17, 2021
NPI 1366963928 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License Licensed in UT · 7964951-4405
5126 W DAYBREAK PKWY, South Jordan, UT 84009

Accepted 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. Jedediah Douglas Kowalski Aprn 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 ID4183997539
PECOS Enrollment IDI20170906001938
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 2024 & 2026 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.
160 services98 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.
41 services35 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
32 services32 patients
Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and G0180
This is a service where a doctor or authorized practitioner certifies that you require Medicare-covered home health services. They will communicate with the home health agency and review reports on your health status to ensure you receive appropriate care. This does not involve an in-person visit.
12 services11 patients

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84009 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
$96.35 typical visit price
range $17.23 – $135.20
Typical copayment $24.08 (range $4.30 – $33.80)
Most-billed visit code 99214
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.

95.7/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality92.19
Promoting Interoperability100
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims 2

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

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
6 suppliers11 claims30 services$4.99 avg. paid by Medicare
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each A4351
DME-Orthotic Devices · category DF008N
3 suppliers15 claims4,050 services$1.40 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.

Pharmacist
5126 W DAYBREAK PKWY
SOUTH JORDAN, UT 84009
Nurse Practitioner
5126 W DAYBREAK PKWY
SOUTH JORDAN, UT 84009
Specialist/Technologist
5126 W DAYBREAK PKWY
SOUTH JORDAN, UT 84009
Plastic Surgery
5126 W DAYBREAK PKWY
SOUTH JORDAN, UT 84009
Pharmacist (Ambulatory Care)
5126 W DAYBREAK PKWY
SOUTH JORDAN, UT 84009
Emergency Medical Technician, Basic
5126 W DAYBREAK PKWY
SOUTH JORDAN, UT 84009
Pharmacist
5126 W DAYBREAK PKWY
SOUTH JORDAN, UT 84009
Pharmacy (Community/Retail Pharmacy)
5126 W DAYBREAK PKWY, ROOM 101
SOUTH JORDAN, UT 84009

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1366963928, enumerated as an "individual" on July 03, 2017.

The provider is located at 5126 W DAYBREAK PKWY SOUTH JORDAN, UT 84009 and the phone number is (801) 656-7647.

Nurse Practitioner with taxonomy code 363LF0000X and a focus in Family.

The provider might be accepting Accepts: BridgeSpan Health Company, Molina Healthcare,. Please consult your insurance carrier or call the provider to verify.

Jedediah Kowalski is affiliated with: UNIVERSITY OF UTAH HOSPITALS AND CLINICS.