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DR. JARED W HENRICKSEN MD
NPI 1396762480
Pediatrics - Pediatric Critical Care Medicine in Slc, UT

Active since July 16, 2006PECOS EnrolledAccepts Medicare Assignment
100 MARIO CAPECCHI DR, SLC, UT 84113(801) 662-1000 Get Directions Write a Review

NPPES record last updated: April 25, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Jared W Henricksen Md NPPES

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

DR. JARED W HENRICKSEN MD (NPI 1396762480) is an individual pediatric critical care medicine provider in Slc, Utah, licensed in Utah (347933-1205) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS and is a graduate of Medical College Of Wisconsin (2002).

NPPES Registry Identity

NPI1396762480
Entity TypeIndividualMale
Primary Taxonomy2080P0203X
Provider Legal NameDR. JARED W HENRICKSENCredential: MD
Location Address100 MARIO CAPECCHI DRSlc, UT 84113-1103
Mailing Address295 Chipeta Way, Po Box 581289Slc, UT 84108-1287 · (801) 587-7563
Phone(801) 662-1000
Sole ProprietorNo
Medical School CMSMedical College Of WisconsinGraduated 2002
Enumeration DateJuly 16, 2006
Last NPPES UpdateApril 25, 2022
NPPES CertifiedApril 25, 2022
✔ NPI 1396762480 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Pediatric Critical Care MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080P0203X
License✔ Licensed in UT · 347933-1205
Definition
A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists.
100 MARIO CAPECCHI DR, Slc, UT 84113
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Jared W Henricksen 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 ID4587669981
PECOS Enrollment IDI20080725000300
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 Reassignments

2

Medicare enrollment records show Jared Henricksen reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Ihc Health Services Inc
Same address
Neonatal-Perinatal Medicine
100 N MARIO CAPECCHI DR
Salt Lake City, UT 84113
  • Reassigned Medicare billing, Utah enrollment
  • 3,691 clinicians in this Medicare group
NPI 1497473375 (801) 442-5000
University Of Utah Pediatric Acuity Care
Same address
Pediatric Emergency Medicine
100 N MARIO CAPECCHI DR
Salt Lake City, UT 84113
  • Reassigned Medicare billing, Utah enrollment
  • 202 clinicians in this Medicare group
NPI 1538523675 (801) 587-6336

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

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.

KAITLIN CARPENTER
Pediatrics
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 662-1000
DR. NICOLE JEFFREYS MD
Anesthesiology (Pediatric Anesthesiology)
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 662-3578
SARAH ZOBELL NP
Nurse Practitioner (Pediatrics)
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 662-1619
MRS. GIOVANA MARTENDAL KING NNP-BC
Nurse Practitioner (Neonatal, Critical Care)
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 662-4100
DR. STEVEN SHI-FONG WU
Pediatrics (Pediatric Gastroenterology)
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 662-2900
KRISTA SKYE VIAU MS, RD, CSP, CD
Dietitian, Registered (Nutrition, Metabolic)
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 587-9590
DR. ANDREW GERALD SMITH M.D.
Pediatrics (Pediatric Critical Care Medicine)
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 662-3673
MARY HUNT MARTIN MD
Pediatrics (Pediatric Cardiology)
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113
Salt Lake County (801) 662-5400

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 Jared Henricksen's NPI number?

The NPI number for Jared Henricksen is 1396762480. It was assigned to this individual provider in the NPPES registry on July 16, 2006.

Where is Jared Henricksen located?

Jared Henricksen practices at 100 Mario Capecchi Dr, Slc, UT 84113. The listed phone number is (801) 662-1000.

What is Jared Henricksen's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Critical Care Medicine, with taxonomy code 2080P0203X.

Is Jared Henricksen enrolled in Medicare?

Yes. Jared Henricksen 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.

Which organizations bill Medicare for Jared Henricksen's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jared Henricksen reassigns Medicare benefits to 2 organizations: Ihc Health Services Inc (Salt Lake City, UT) and University Of Utah Pediatric Acuity Care (Salt Lake City, UT). Each 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 Jared Henricksen's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jared Henricksen was last updated on April 25, 2022. 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.