SAMUEL MCCLELLAN JACOBSEN
NPI 1720701766
Family Medicine in Layton, UT

Q: What is Samuel Jacobsen's NPI number?

The NPI number for Samuel Jacobsen is 1720701766. It was assigned to this individual provider in the NPPES registry on September 23, 2022.

Q: What is Samuel Jacobsen's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Samuel Jacobsen was last updated on November 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.

Active since September 23, 2022PECOS Enrolled

201 W LAYTON PKWY STE 1A, LAYTON, UT 84041(801) 543-6875 Get Directions Write a Review

NPPES record last updated: November 25, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Nov 25, 2025, Sep 23, 2022 (2 updates tracked since 2022).

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About Samuel Mcclellan Jacobsen NPPES

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

SAMUEL MCCLELLAN JACOBSEN (NPI 1720701766) is an individual family medicine provider in Layton, Utah, licensed in Utah (14234126-1204) and active in the NPI registry since September 2022. He is enrolled in Medicare PECOS, is affiliated with Mckay-dee Hospital, and is a graduate of Oklahoma State University College Of Osteopathic Medicine (2024).

NPPES Registry Identity

NPI1720701766

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameSAMUEL MCCLELLAN JACOBSEN

Location Address201 W LAYTON PKWY STE 1ALayton, UT 84041-3692

Mailing AddressPo Box 27128Salt Lake City, UT 84127-0128

Phone(801) 543-6875

Sole ProprietorNo

Medical School CMSOklahoma State University College Of Osteopathic MedicineGraduated 2024

Enumeration DateSeptember 23, 2022

Last NPPES UpdateNovember 25, 20252 updates tracked since enumeration

NPPES CertifiedNovember 25, 2025

✔ NPI 1720701766 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in UT · 14234126-1204

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

201 W LAYTON PKWY STE 1A, Layton, UT 84041

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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 (PECOS)

Samuel Mcclellan Jacobsen is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID446744478

PECOS Enrollment IDI20251208003536

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 Samuel Jacobsen reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Ihc Health Services Inc

Same address

Obstetrics & Gynecology

201 W LAYTON PARKWAY
Layton, UT 84041

Reassigned Medicare billing, Utah enrollment
3,691 clinicians in this Medicare group

NPI 1053832501 (801) 442-1853

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

Hospital Affiliations CMS Care Compare

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84041 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.

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FERNANDO RIVERO PA, MPAS, MPH

Physician Assistant