Shane Jaimez, NP is a medicare enrolled "Nurse Practitioner - Family" in Salt Lake Cty, Utah. His current practice location is
5097 S 900 E Ste 100, Salt Lake Cty, Utah. You can reach out to his office (for appointments etc.) via phone at
(801) 851-5554.
Shane Jaimez is licensed to practice in Utah (license number 10975826-4405) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1780156661.
Provider's Profile
| Full Name | Shane Jaimez |
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| Gender | Male |
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| Speciality | Nurse Practitioner - Family |
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| Location | 5097 S 900 E Ste 100, Salt Lake Cty, Utah |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1780156661
- Provider Enumeration Date: 12/17/2018
- Last Update Date: 11/28/2023
Medicare PECOS Information:
- PECOS PAC ID: 0749510931
- Enrollment ID: I20191002000382
Medical Identifiers
Medical identifiers for Shane Jaimez such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1780156661 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LF0000X | Nurse Practitioner - Family | 10975826-4405 (Utah) | Primary |
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. Shane Jaimez allows following entities to bill medicare on his behalf.
| Entity Name | Hope Family Medical Center Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1134570328
PECOS PAC ID: 4385927185
Enrollment ID: O20170201001263 |
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| Entity Name | Kindly Md, Inc. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1225647480
PECOS PAC ID: 8921471897
Enrollment ID: O20230224001420 |
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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. Shane Jaimez 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 |
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Shane Jaimez, NP
5097 S 900 E Ste 100,
Salt Lake Cty, UT 84117-5725
Ph: (801) 851-5554 | Shane Jaimez, NP
5097 S 900 E Ste 100,
Salt Lake Cty, UT 84117-5725
Ph: (801) 851-5554 |
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