NPIMap

Individual provider Active NPI

Matthew Kenneth Redd, D.O.

  • Internal Medicine Physician
  • Ogden, UT
National Provider Identifier
1154642791
Registry record updated Jul 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5115898-1204 Issued in UT
Practice address
6028 S Ridgeline Dr
201
Ogden, UT 84405-6914
Phone
(801) 475-5400
Fax
(801) 475-8614
NPI assigned
Jun 17, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2013012534 MO
Internal Medicine Physician 207R00000X 5115898-1204 UT Primary

Addresses

Primary practice location

6028 S Ridgeline Dr
201
Ogden, UT 84405-6914

Mailing address

6028 S Ridgeline Dr
Ste 201
South Ogden, UT 84405-6908
Phone (801) 475-5400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160711000979 UT Practitioner - Gastroenterology 8123251089 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Arizona College of Osteopathic Medicine Mid Western University, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tanner Memorial ClinicGroup PAC ID 4284547985, 251 clinicians

Practice addresses (Care Compare)

2121 N 1700
Layton, UT 84041-8803
Phone (801) 773-4840

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy268
Upper gastrointestinal (GI) endoscopy for acid reflux379

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2013012534MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tanner Memorial Clinic Internal Medicine CurrentSince Aug 1, 2018 Accepting new patients
Tanner Memorial Clinic CurrentSince Aug 1, 2018 Accepting new patients
Ridgeline Endoscopy Center L.C. Past Accepting new patients
Rosenberg Cooley Metcalf LC Past Accepting new patients

Locations

2132 N Robins Dr
Layton, UT 84041
Phone (801) 728-0600

425 S 100 W
Layton, UT 84041
Phone (801) 525-8726

2132 N Robins Dr
Ste 310
Layton, UT 84041

6028 S Ridgeline Dr
Ogden, UT 84405
Phone (385) 432-5838

6028 S Ridgeline Dr
Ste 201
South Ogden, UT 84405
Phone (801) 475-5400

Networks

  • UT PPO D-SNP
  • UT PPO

Interoperability endpoints

  • Direct secure messaging: matthew.redd.p1@direct.tannerclinic.nextgenshare.com

Organizations & group practices 4

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 4

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": "1276732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467676800000",
    "number": "1154642791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6028 S RIDGELINE DR",
            "address_2": "STE 201",
            "city": "SOUTH OGDEN",
            "state": "UT",
            "postal_code": "844056908",
            "telephone_number": "801-475-5400",
            "fax_number": "801-475-8614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6028 S RIDGELINE DR",
            "address_2": "201",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844056914",
            "telephone_number": "801-475-5400",
            "fax_number": "801-475-8614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDD",
        "first_name": "MATTHEW",
        "middle_name": "KENNETH",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-17",
        "last_updated": "2016-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2013012534",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "5115898-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

Verify at the official NPI Registry.