Matthew R Peverill, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5251-57 Issued in WI

Practice address

700 Ray O Vac Dr Ste 220
Madison, WI 53711-2476

Phone

(608) 276-9191

NPI assigned

Oct 29, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

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

Clinical Psychologist

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Therapy Center of Madison, Inc. 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• Family Therapy Center of Madison, Inc.

  • Clinical Social Worker
  • Madison, WI
  • NPI 1164587150

  Clinical, WI

  Medicare reassignment Care Compare group NPD
• Peter C. Jackson, PSYD Consulting, SC

  • Clinical Psychologist
  • Madison, WI
  • NPI 1881058675

  Clinical

  NPD

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

{
    "created_epoch": "1730160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1114749249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4314 CRITCHELL TER",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537111535",
            "telephone_number": "857-277-9083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 RAY O VAC DR STE 220",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537112476",
            "telephone_number": "608-276-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEVERILL",
        "first_name": "MATTHEW",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-10-29",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "WI",
            "license": "5251-57",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "WI",
            "license": "5251-57",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "5251-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Marie Petterson
• Brian E Petty, SLP
• David William Petty, RPH
• Dominique Lawrence Petty
• Elizabeth Marie Petty, MD
• Lynn M Peyton, LCSW
• Andrew S Pfaff, M.D.
• Katherine Pfaff
• Joseph Shawn Pfaller, M.S.
• Bailey R Pfander, PA

• All providers in Madison, WI
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.