CHARLIE R JACQUES (APRN) – Nurse Practitioner, NPI 1336162890
Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,655 NURSE PRACTITIONER in UT
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Provider Addresses for CHARLIE R JACQUES (APRN)
PO BOX 27128
SALT LAKE CITY, UT 841270128
Phone: (435) 251-2600
Type: Mailing
1380, Medical Center Drive, St. George, Washington County, Utah, 84790, United States
SUITE #1400
ST GEORGE, UT 847902123
Phone: (435) 251-2600
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 124 Open Payments records for all available years, with a total value of $1,710.
Total Amount is formed as General ($1,710) + Research ($0) + Ownership ($0) = $1,710.
Last reported payment date: 2024-12-30 • Largest payer in this snapshot: Lilly USA, LLC ($396).
Total Amount
$1,710
General + Research + Ownership
Payments
124
Total payment records
General Amount
$1,710
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-30
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Lilly USA, LLC | $396 |
| Abbott Laboratories | $356 |
| Novo Nordisk Inc | $183 |
| BETA BIONICS, INC. | $98 |
| Radius Health, Inc. | $79 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-03-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050330000667 | I | Nurse Practitioner | UT | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 349 | 163 | $0 |
| 95251 | Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with interpretation and report | 165 | 106 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 33 | 30 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 17 | 17 | $0 |
Insurance plans in this area (ZIP 84127)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| NURSE PRACTITIONER | UT | 83036 | Hemoglobin A1C level | 30 | 23 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OR | |
| Diagnostic Radiology | UT | |
| Family Practice | UT | |
| H O S P I T A L I S T | UT | |
| O B S T E T R I C S/ G Y N E C O L O G Y | UT | |
| - | UT | |
| - | UT | |
| - | UT | |
| Family Practice | UT | |
| - | UT |
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