Individual provider Active NPI

Matthew Irvin, D.O.

  • Physical Medicine & Rehabilitation Physician
  • St George, UT
National Provider Identifier
1043644040
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
11368809-1204 Issued in UT
Practice address
2825 E Mall Dr
St George, UT 84790-1954
Phone
(801) 354-8225
Fax
(435) 627-1809
NPI assigned
Aug 26, 2013
Last updated
Mar 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 11368809-1204 UT Primary

Addresses

Primary practice location

2825 E Mall Dr
St George, UT 84790-1954

Mailing address

1055 N 500 W
Att: Credentialing
Provo, UT 84604
Phone (801) 354-8225

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, UT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180904002487 WA Practitioner - Physical Medicine and Rehabilitation 7416260294
I20200910002686 UT Practitioner - Physical Medicine and Rehabilitation 7416260294 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Revere Health PCGroup PAC ID 7517868508, 407 clinicians

Practice addresses (Care Compare)

2825 E Mall Dr
St George, UT 84790-1954
Phone (435) 673-6131

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
11368809-1204UTMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Revere Health PC CurrentSince Nov 1, 2020 Accepting new patients
Revere Health PC CurrentSince Nov 1, 2020 Accepting new patients

Locations

1870 N Main St
Ste 201
Cedar City, UT 84721
Phone (435) 383-9009

1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000

1055 N 500 W
Ste 212
Provo, UT 84604
Phone (801) 374-2362

1424 E Foremaster Dr
Ste 120
St George, UT 84790
Phone (435) 656-8800

2825 E Mall Dr
St George, UT 84790
Phone (435) 673-6131

Networks

  • UT PPO D-SNP
  • UT PPO

Interoperability endpoints

  • Direct secure messaging: matthewirvin@cuccu.allscriptsdirect.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1043644040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "ATT: CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "84604",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 E MALL DR",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847901954",
            "telephone_number": "801-354-8225",
            "fax_number": "435-627-1809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRVIN",
        "first_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-26",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "UT",
            "license": "11368809-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St George, UT

Sources for this page

Verify at the official NPI Registry.