Matthew Nicholas Otto, TCADC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

290511 Issued in KY

Practice address

600 Perimeter Dr Ste 125
Lexington, KY 40517-4296

Phone

(866) 678-8123

NPI assigned

Dec 17, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Roaring Brook LLCGroup PAC ID 5092231498, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Roaring Brook LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Lexington, KY
  • NPI 1053934836
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1608163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1053907634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 DAWSON SPRINGS WAY",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405112315",
            "telephone_number": "928-830-9476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 PERIMETER DR STE 125",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405174296",
            "telephone_number": "866-678-8123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTO",
        "first_name": "MATTHEW",
        "middle_name": "NICHOLAS",
        "credential": "TCADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-17",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "KY",
            "license": "290511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Osptky LLC
• Katie Oster, O.D
• Morgan Elizabeth Ostinowsky, PHARMD
• Anthony Sunday Otekeiwebia, M.D
• Danielle Otto, PHARMD
• Brahim Ouberni
• Lateisha Sharae Ousley, ENGAGEMENT SPECIALIS
• Betty Ouyang, MD
• Ashley Overbay
• Tracie L Overbeck, MD, PHD

• Counselor in Lexington, KY
• Providers in Lexington, KY by specialty
• Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.