Individual provider Active NPI

Matthew Boushka, MD

  • Anesthesiology Physician
  • Murray, UT
National Provider Identifier
1215322904
Registry record updated Dec 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
12466819-1205 Issued in UT
Practice address
5121 S Cottonwood St
Murray, UT 84107-5701
Phone
(801) 507-7000
NPI assigned
Mar 31, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 29, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X DR.0063628 CO
Student in an Organized Health Care Education/Training Program 390200000X
Anesthesiology Physician 207L00000X 12466819-1205 UT Primary

Addresses

Primary practice location

5121 S Cottonwood St
Murray, UT 84107-5701

Mailing address

138 E 12300 S Unit 370
Draper, UT 84020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20220214000790 UT Practitioner - Anesthesiology 4082920426 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Tennessee, HSC, College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain West Anesthesia LLCGroup PAC ID 9032018502, 267 clinicians

Practice addresses (Care Compare)

5121 S Cottonwood St
Murray, UT 84107-5701
Phone (801) 507-7000

Hospital & facility affiliations

  • Intermountain Health Alta View Hospital Hospital, Sandy, UT, CCN 460044
  • Intermountain Health Utah Valley Hospital Hospital, Provo, UT, CCN 460001

Merit-based Incentive Payment System (MIPS)

Final score
87.53 of 100Reported as group
Quality
89.3
Improvement activities
40
Cost
78.06

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0063628COMDAnesthesiology Physician
12466819-1205UTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain West Anesthesia LLC Anesthesiology CurrentSince Jan 1, 2022 Accepting new patients

Locations

3340 N Center St
Ste 800
Lehi, UT 84043
Phone (800) 501-4788

5121 S Cottonwood St
Salt Lake Cty, UT 84107
Phone (801) 408-8998

150 W Civic Center Dr
Ste 200
Sandy, UT 84070
Phone (801) 727-2056

Organizations & group practices 1

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 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": "1427760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1215322904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 E 12300 S UNIT 370",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "84020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5121 S COTTONWOOD ST",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075701",
            "telephone_number": "801-507-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUSHKA",
        "first_name": "MATTHEW",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-31",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CO",
            "license": "DR.0063628",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "12466819-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

Verify at the official NPI Registry.