Active NPI
Matthew Weston Pommerville, FNP
- Family Nurse Practitioner
- Park City, UT
National Provider Identifier
1003425356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 8038057-4405
- Practice address
- 1600 Snow Creek Dr
Park City, UT 84060-7372 - Phone
- (435) 655-0055
- Fax
- (435) 655-8979
- NPI assigned
- Jul 23, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 8038057-4405 | UT | Primary |
Addresses
Primary practice location
1600 Snow Creek Dr
Park City, UT 84060-7372
Mailing address
PO Box 198560
Atlanta, GA 30384-8560
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221111000035 | UT | Order and Referring Only - Nurse Practitioner | 5395163729 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613606400000",
"number": "1003425356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 198560",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303848560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 SNOW CREEK DR",
"city": "PARK CITY",
"state": "UT",
"postal_code": "840607372",
"telephone_number": "435-655-0055",
"fax_number": "435-655-8979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POMMERVILLE",
"first_name": "MATTHEW",
"middle_name": "WESTON",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-23",
"last_updated": "2021-02-18",
"certification_date": "2021-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "UT",
"license": "8038057-4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.