Active NPI
William Matt Clark, MD
- Anesthesiology Physician
- Salt Lake City, UT
National Provider Identifier
1386759041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 170625-1205
- Practice address
- 100 N Medical Dr
Salt Lake City, UT 84113-1103 - Phone
- (801) 588-3272
- Fax
- (801) 588-3279
- NPI assigned
- Aug 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 170625-1205 | UT | Primary |
Addresses
Primary practice location
100 N Medical Dr
Salt Lake City, UT 84113-1103
Mailing address
1954 Fort Union Blvd
111
Salt Lake City, UT 84121-6800
Phone (801) 993-9551
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PRA01666 | Other | UT | MOLINA |
| 107010384101 | Other | UT | IHC |
| QM0000049510 | Other | UT | ALTIUS |
| 17965 | Other | UT | PEHP |
| 401765 | Medicaid | MT | |
| 2000040 | Other | UT | UNITED HEALTHCARE |
| 2430 | Other | UT | HEALTHY U |
| 416932 | Other | UT | DESERET MUTUAL |
| 870280408CL2 | Other | UT | EDUCATORS MUTUAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 170625-1205 | UT | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386759041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1954 FORT UNION BLVD",
"address_2": "111",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841216800",
"telephone_number": "801-993-9551",
"fax_number": "801-733-5872"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N MEDICAL DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841131103",
"telephone_number": "801-588-3272",
"fax_number": "801-588-3279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "WILLIAM",
"middle_name": "MATT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "UT",
"license": "170625-1205",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOLINA",
"identifier": "PRA01666",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IHC",
"identifier": "107010384101",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALTIUS",
"identifier": "QM0000049510",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEHP",
"identifier": "17965",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "401765",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "2000040",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHY U",
"identifier": "2430",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DESERET MUTUAL",
"identifier": "416932",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EDUCATORS MUTUAL",
"identifier": "870280408CL2",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.