NPIMap

Individual provider Active NPI

Matthew David Wagaman, MD

  • Anesthesiology Physician
  • Provo, UT
National Provider Identifier
1083906952
Registry record updated Sep 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
22241 Issued in ND
Practice address
1034 N 500 W
Provo, UT 84604-3380
Phone
(801) 357-7850
Fax
(770) 701-6675
NPI assigned
May 10, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 24, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 4301096041 MI
Anesthesiology Physician 207L00000X 22241 ND Primary
Anesthesiology Physician 207L00000X 9395169-1205 UT

Addresses

Primary practice location

1034 N 500 W
Provo, UT 84604-3380

Mailing address

PO Box 3570
Salt Lake City, UT 84110-3570
Phone (801) 727-2056

Other practice location 1

2305 37th Ave SW
Minot, ND 58701-7669
Phone (701) 418-8000

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, ND2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150622002519 UT Practitioner - Anesthesiology 7012134968 Reassigns benefits to 2 organizations
I20250331002639 ND Practitioner - Anesthesiology 7012134968 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain West Anesthesia LLCGroup PAC ID 9032018502, 267 clinicians
Trinity HealthGroup PAC ID 7911816020, 292 clinicians

Practice addresses (Care Compare)

1034 N 500
Provo, UT 84604-3380
Phone (801) 357-7850

1380 E Medical Ctr Dr
St George, UT 84790-2123
Phone (435) 251-1000

150 W Civic Ctr Dr
Suite 200
Sandy, UT 84070-4284
Phone (801) 727-2056

2305 37TH Ave SW
Minot, ND 58701-7669
Phone (701) 418-8000

765 E Marker Place Dr
Spanish Fork, UT 84660-1396
Phone (385) 344-5000

Hospital & facility affiliations

  • Intermountain Health Utah Valley Hospital Hospital, Provo, UT, CCN 460001
  • Trinity Hospitals Hospital, Minot, ND, CCN 350006
  • Intermountain Health Spanish Fork Hospital Hospital, Spanish Fork, UT, CCN 460062

Merit-based Incentive Payment System (MIPS)

Final score
87.53 of 100Reported as group
Quality
89.3
Improvement activities
40
Cost
78.06

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301096041MIMDAnesthesiology Physician
22241NDMDAnesthesiology Physician
9395169-1205UTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain West Anesthesia LLC Anesthesiology CurrentSince Jul 1, 2015 Accepting new patients
Trinity Health Current Accepting new patients
Ihc Health Services Inc CurrentSince Mar 1, 2020 Accepting new patients
Ihc Health Services Inc Family Medicine Current Accepting new patients
Ihc Health Services, Inc. CurrentSince Mar 1, 2020 Accepting new patients
Trinity Health CurrentSince Mar 19, 2025 Accepting new patients
Trinity Health CurrentSince Mar 19, 2025 Accepting new patients

Locations

2720 Dundee Rd
Northbrook, IL 60062
Phone (224) 226-5222

2305 37th Ave SW
Minot, ND 58701
Phone (701) 418-8550

101 3rd Ave SW
Minot, ND 58701
Phone (701) 857-5286

3340 N Center St
Ste 800
Lehi, UT 84043
Phone (800) 501-4788

1034 N 500 W
Provo, UT 84604
Phone (801) 362-4119

150 W Civic Center Dr
Ste 200
Sandy, UT 84070
Phone (801) 727-2056

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992

Organizations & group practices 7

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.

Hospital & facility affiliations 10

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": "1304985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758672000000",
    "number": "1083906952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3570",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841103570",
            "telephone_number": "801-727-2056",
            "fax_number": "770-701-6675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 N 500 W",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043380",
            "telephone_number": "801-357-7850",
            "fax_number": "770-701-6675"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2305 37th Ave SW",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587017669",
            "country_code": "US",
            "telephone_number": "701-418-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGAMAN",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-10",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301096041",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "ND",
            "license": "22241",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "9395169-1205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.