1. Home
  2. Directory
  3. Utah
  4. Salt Lake City
  5. Clinic Center
  6. NPI Profile

BRUCE K JACOBSON PH D P C
NPI 1417913575
Clinic/Center - Adult Mental Health in Salt Lake City, UT

Active since April 26, 2006
4190 HIGHLAND DR, SUITE 211, SALT LAKE CITY, UT 84124(801) 272-0614(801) 272-0678 Get Directions Write a Review

NPPES record last updated: March 16, 2018. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Bruce K Jacobson Ph D P C NPPES

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

BRUCE K JACOBSON PH D P C (NPI 1417913575) is a healthcare organization registered as an adult mental health in Salt Lake City, Utah and active in the NPI registry since April 2006. The organization lists Bruce K Jacobson, President And Psychologist, as its authorized official.

NPPES Registry Identity

NPI1417913575
Entity TypeOrganization
Primary Taxonomy261QM0850X
Legal Business NameBRUCE K JACOBSON PH D P C
Location Address4190 HIGHLAND DR, SUITE 211Salt Lake City, UT 84124-2600
Mailing Address4190 Highland Dr, Suite 211Salt Lake City, UT 84124-2600 · (801) 272-0614 · Fax (801) 272-0678
Phone(801) 272-0614
Fax(801) 272-0678
Organization SubpartNo
Authorized OfficialBruce K JacobsonPresident And Psychologist · (801) 272-0614
Enumeration DateApril 26, 2006
Last NPPES UpdateMarch 16, 2018
✔ NPI 1417913575 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Adult Mental HealthAmbulatory Health Care Facilities
Taxonomy Code261QM0850X
License✔ Licensed in UT · 1162592501
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.
4190 HIGHLAND DR, Salt Lake City, UT 84124
Open in Google Maps ↗

Accepted Insurance

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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Bruce K Jacobson Ph D P C is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Bruce K Jacobson Ph D P C, which bills Medicare for the services this clinician delivers.

Clinician (1)

Bruce Jacobson, PH.D., P.C.
Clinical Psychologist
NPI 1679743009
4190 HIGHLAND DR SUITE 211
Salt Lake City, UT 84124
(801) 272-0614
✔ PECOS✔ Accepts MedicareSame address

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

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 Bruce K Jacobson Ph D P C's NPI number?

The NPI number for Bruce K Jacobson Ph D P C is 1417913575. It was assigned to this organization in the NPPES registry on April 26, 2006.

Where is Bruce K Jacobson Ph D P C located?

Bruce K Jacobson Ph D P C is located at 4190 Highland Dr Suite 211, Salt Lake City, UT 84124. The listed phone number is (801) 272-0614.

What is Bruce K Jacobson Ph D P C's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Adult Mental Health, with taxonomy code 261QM0850X.

Is Bruce K Jacobson Ph D P C enrolled in Medicare?

Yes. Bruce K Jacobson Ph D P C is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Bruce K Jacobson Ph D P C?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Bruce K Jacobson Ph D P C. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Bruce K Jacobson Ph D P C accept?

Health plans from Molina Healthcare and University of Utah Health Plans list Bruce K Jacobson Ph D P C 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 Bruce K Jacobson Ph D P C was last updated on March 16, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.