JASON LEE BLACKHAM (M.D.) – Sports Medicine (Internal Medicine) Physician, NPI 1821293242
Sports Medicine (Internal Medicine) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
105 SPORTS MEDICINE in UT
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Provider Addresses for JASON LEE BLACKHAM (M.D.)
PO BOX 27128
SALT LAKE CITY, UT 841270128
Phone: (801) 387-2750
Fax: (801) 387-2755
Type: Mailing
4403, Harrison Boulevard, Ogden, Weber County, Utah, 84403, United States
SUITE 2400
OGDEN, UT 844033271
Phone: (801) 387-2750
Fax: (801) 387-2755
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2009-01-15
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 |
|---|---|---|---|---|
| I20090115000041 | I | Sports Medicine | 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 |
|---|---|---|---|---|
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 429 | 93 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 260 | 151 | $0 |
| 20610 | Aspiration and/or injection of fluid from large joint | 164 | 95 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 141 | 141 | $0 |
| 73562 | X-ray of knee, 3 views | 81 | 79 | $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 |
|---|---|---|---|---|---|
| SPORTS MEDICINE | UT | 73562 | X-ray of knee, 3 views | 107 | 101 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Emergency Medicine | UT | |
| - | OR | |
| Diagnostic Radiology | 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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