Jacob Stout, is a medicare enrolled "Physician Assistant" in South Salt Lake, Utah. His current practice location is
2472 S 300 E, South Salt Lake, Utah. You can reach out to his office (for appointments etc.) via phone at
(801) 783-5011.
Jacob Stout is licensed to practice in Utah (license number 13593511-1206) 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 1952037939.
Provider's Profile
Full Name | Jacob Stout |
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Gender | Male |
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Speciality | Physician Assistant |
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Location | 2472 S 300 E, South Salt Lake, Utah |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1952037939
- Provider Enumeration Date: 08/01/2022
- Last Update Date: 11/01/2023
Medicare PECOS Information:
- PECOS PAC ID: 4183071053
- Enrollment ID: I20231114003517
Medical Identifiers
Medical identifiers for Jacob Stout such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1952037939 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
363A00000X | Physician Assistant | 13593511-1206 (Utah) | Primary |
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. Jacob Stout 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 |
Jacob Stout, 1118 Moyle Dr, Alpine, UT 84004-1200 Ph: () - | Jacob Stout, 2472 S 300 E, South Salt Lake, UT 84115-2895 Ph: (801) 783-5011 |
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