NPIMap

Individual provider Active NPI

Matthew John Welter, M.D.

  • Family Medicine Physician
  • Logan, UT
National Provider Identifier
1164486064
Registry record updated Dec 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5934541-1205 Issued in UT
Practice address
1219 N 400 E
Logan, UT 84341-2321
Phone
(435) 757-8943
NPI assigned
Apr 17, 2006
Last updated
Dec 7, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5934541-1205 UT Primary

Addresses

Primary practice location

1219 N 400 E
Logan, UT 84341-2321

Mailing address

1915 E 13000 N
Cove, UT 84320-2130
Phone (435) 713-1300

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
I20060113000864 UT Practitioner - Family Practice 3274426374 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Living Tree Medical GroupGroup PAC ID 5294128963, 5 clinicians

Practice addresses (Care Compare)

169 N Gateway Dr
Suite 170
Providence, UT 84332-9855
Phone (435) 565-6043

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Living Tree Medical Group Family Medicine CurrentSince Sep 22, 2021 Accepting new patients
Matthew J Welter MD PC Family Medicine PastSince Sep 15, 2005 Accepting new patients

Locations

1219 N 400 E
North Logan, UT 84341
Phone (435) 565-6043

1635 N 200 E
North Logan, UT 84341
Phone (435) 565-6043

169 N Gateway Dr
Ste 170
Providence, UT 84332
Phone (435) 565-6043

Organizations & group practices 3

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 7

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": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607299200000",
    "number": "1164486064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1915 E 13000 N",
            "city": "COVE",
            "state": "UT",
            "postal_code": "843202130",
            "telephone_number": "435-713-1300",
            "fax_number": "435-787-7601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1219 N 400 E",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412321",
            "telephone_number": "435-757-8943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELTER",
        "first_name": "MATTHEW",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-17",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "5934541-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, UT

Sources for this page

Verify at the official NPI Registry.