Individual provider Active NPI

Matthew D. Torbenson, MD

  • Psychiatry Physician
  • Provo, UT
National Provider Identifier
1104455724
Registry record updated Jul 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
12476450-1205 Issued in UT
Practice address
395 W Cougar Blvd Ste 601
Provo, UT 84604-3331
Phone
(801) 357-7525
NPI assigned
Apr 6, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 12476450-1205 UT Primary

Addresses

Primary practice location

395 W Cougar Blvd Ste 601
Provo, UT 84604-3331

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128

Other practice location 1

501 S Chipeta Way
Salt Lake City, UT 84108-1222
Phone (801) 581-4096

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io.8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240321004201 ID Practitioner - Psychiatry 3375940364 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Life Change Associates PCGroup PAC ID 8224265574, 7 clinicians
Idaho State UniversityGroup PAC ID 4688683030, 19 clinicians

Practice addresses (Care Compare)

2520 S 5TH Ave
Pocatello, ID 83204-1923
Phone (208) 233-5433

421 Memorial Dr
Pocatello, ID 83201-4008
Phone (208) 282-2434

Hospital & facility affiliations

  • Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho State University Current Accepting new patients
Optimum Health, PLLC CurrentSince Feb 6, 2024 Accepting new patients
Life Change Associates, PC Psychiatry CurrentSince Jul 1, 2025 Accepting new patients
Idaho State University CurrentSince Jul 11, 2025 Accepting new patients
Idaho State University CurrentSince Jul 11, 2025 Accepting new patients
Idaho State University Past Accepting new patients

Locations

1441 Parkway Dr
Blackfoot, ID 83221
Phone (208) 785-2600

1404 Pomerelle Ave
Ste 150
Burley, ID 83318
Phone (208) 233-5433

730 S Woodruff Ave
Idaho Falls, ID 83401
Phone (208) 233-5433

1311 E Central Dr
Meridian, ID 83642
Phone (208) 373-1734

2520 S 5th Ave
Pocatello, ID 83204
Phone (208) 233-5433

500 S 11th Ave
Ste 501
Pocatello, ID 83201
Phone (208) 232-7434

421 Memorial Dr
Pocatello, ID 83201
Phone (208) 234-7900

421 Memorial Dr
Bldg 82
Pocatello, ID 83201

Interoperability endpoints

  • Direct secure messaging: mtorbenson330714@ahs.direct-ci.com

Organizations & group practices 6

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 2

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": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785110400000",
    "number": "1104455724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 W COUGAR BLVD STE 601",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043331",
            "telephone_number": "801-357-7525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 S Chipeta Way",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841081222",
            "country_code": "US",
            "telephone_number": "801-581-4096",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TORBENSON",
        "first_name": "MATTHEW",
        "middle_name": "D.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-06",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "UT",
            "license": "12476450-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io.8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.