Individual provider Active NPI

Matthew Naegle, DO

  • Pediatrics Physician
  • Ogden, UT
National Provider Identifier
1154850477
Registry record updated May 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
70007041204 Issued in UT
Practice address
698 12TH St
Ogden, UT 84404-6200
Phone
(801) 475-3700
Fax
(801) 475-3701
NPI assigned
Jun 8, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X R-10913 IA
Pediatrics Physician 208000000X 70007041204 UT Primary

Addresses

Primary practice location

698 12TH St
Ogden, UT 84404-6200

Mailing address

PO Box 5546
Denver, CO 80217-5546
Phone (801) 475-3500

Other identifiers 1

IdentifierTypeStateIssuer
1154850477MedicaidUT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, GU2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200714003591 UT Practitioner - Pediatric Medicine 5092132530 Reassigns benefits to 2 organizations
I20241018000034 GU Practitioner - Pediatric Medicine 5092132530 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R-10913IAMDPediatrics Physician
70007041204UTMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Guam Memorial Hospital CurrentSince Aug 5, 2024 Accepting new patients
Guam Memorial Hospital CurrentSince Aug 5, 2024 Accepting new patients
Ogden Clinic PC Pediatrics CurrentSince Aug 1, 2020 Accepting new patients
Tanner Memorial Clinic CurrentSince Feb 1, 2025 Accepting new patients
Tanner Memorial Clinic Pediatrics Current Accepting new patients
Tanner Memorial Clinic CurrentSince Feb 1, 2025 Accepting new patients

Locations

850 Gov Carlos G Camacho Rd
Tamuning, GU 96913
Phone (671) 647-2555

850 Gov Carlos G Camacho Rd
#R
Tamuning, GU 96913
Phone (671) 647-2552

444 W Bourne Cir
Farmington, UT 84025

425 S 100 W
Layton, UT 84041
Phone (801) 682-8708

698 12th St
Ogden, UT 84404
Phone (801) 475-3700

1159 12th St
Ogden, UT 84404
Phone (801) 475-3700

5495 S 500 E
Ste 310
Ogden, UT 84405
Phone (801) 475-3100

6112 S Harrison
South Ogden, UT 84405
Phone (801) 475-3800

Interoperability endpoints

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

NPI Registry JSON

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

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620086400000",
    "number": "1154850477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5546",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802175546",
            "telephone_number": "801-475-3500",
            "fax_number": "801-475-3494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "698 12TH ST",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844046200",
            "telephone_number": "801-475-3700",
            "fax_number": "801-475-3701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAEGLE",
        "first_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-08",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IA",
            "license": "R-10913",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "70007041204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154850477",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

Verify at the official NPI Registry.