Jake Fagan, MD in Provo, UT - Medicare Micrographic Dermatologic Surgery (mds)

Jake Fagan, MD is a medicare enrolled "Dermatology - Mohs-micrographic Surgery" physician in Provo, Utah. He went to West Virginia University School Of Medicine and graduated in 2014 and has 11 years of diverse experience with area of expertise as Micrographic Dermatologic Surgery (mds). He is a member of the group practice Central Utah Clinic Pc and his current practice location is 1055 N 500 W # 111, Provo, Utah. You can reach out to his office (for appointments etc.) via phone at (801) 374-8999.

Jake Fagan is licensed to practice in Utah (license number 6845592-1205) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1548688989.

Contact Information

	Jake Fagan, MD
	1055 N 500 W # 111, Provo, UT 84604-3305
	(801) 374-8999
	Not Available

Map and Direction

Physician's Profile

Full Name	Jake Fagan
Gender	Male
Speciality	Micrographic Dermatologic Surgery (mds)
Experience	11 Years
Location	1055 N 500 W # 111, Provo, Utah
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Jake Fagan attended and graduated from West Virginia University School Of Medicine in 2014

NPI Data:

NPI Number: 1548688989
Provider Enumeration Date: 04/02/2014
Last Update Date: 04/17/2024

Medicare PECOS Information:

PECOS PAC ID: 3577868264
Enrollment ID: I20240522002957

Medical Identifiers

Medical identifiers for Jake Fagan such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1548688989	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207N00000X	Dermatology	MED-PHYS-LIC-76211 (Montana)	Secondary
207ND0101X	Dermatology - Mohs-micrographic Surgery	MED-PHYS-LIC-76211 (Montana)	Secondary
207ND0101X	Dermatology - Mohs-micrographic Surgery	76211 (Montana)	Secondary
2086X0206X	Surgery - Surgical Oncology	MED-PHYS-LIC-76211 (Montana)	Secondary
390200000X	Student In An Organized Health Care Education/training Program	(* (Not Available))	Secondary
207ND0101X	Dermatology - Mohs-micrographic Surgery	6845592-1205 (Utah)	Primary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Central Utah Clinic Pc	7517868508	388

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jake Fagan allows following entities to bill medicare on his behalf.

Entity Name	Central Utah Clinic Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1093764805 PECOS PAC ID: 7517868508 Enrollment ID: O20040113000805

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jake Fagan is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Jake Fagan, MD 1055 N 500 W, Att Credentialing, Provo, UT 84604 Ph: (801) 354-8225	Jake Fagan, MD 1055 N 500 W # 111, Provo, UT 84604-3305 Ph: (801) 374-8999

Reviews and Comments

Dermatology Doctors in Provo, UT

Dr. Payam Tristani-firouzi, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 1055 N 500 W Ste 111, Provo, UT 84604 Phone: 801-374-8999 Fax: 801-429-8063
Dr. Richard L Stone, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 1275 N University Ave Ste 23, Provo, UT 84604 Phone: 801-377-4745 Fax: 801-373-5762
Garrett C Lowe, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 3200 N Canyon Rd Ste D, Provo, UT 84604 Phone: 801-373-3300 Fax: 801-354-7900
Mr. Gregory J Wing, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 1055 N 500 W Ste 111, Provo, UT 84604 Phone: 801-354-8225 Fax: 801-418-0941
Margaret Hammond, Dermatology Medicare: Accepting Medicare Assignments Practice Location: 395 W Cougar Blvd Ste 604, Provo, UT 84604 Phone: 801-357-0613
Brian R Bradshaw, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 1055 N 500 W, Suite 111, Provo, UT 84604 Phone: 801-374-8999 Fax: 801-429-8063

Jake Fagan, MD - Medicare Micrographic Dermatologic Surgery (mds) in Provo, UT