NPIMap

Individual provider Active NPI

Matthew Steven Cobb, PA-C

  • Physician Assistant
  • Salt Lake City, UT
National Provider Identifier
1528099710
Registry record updated May 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
217465-1206 Issued in UT
Practice address
54 N 800 W
Salt Lake City, UT 84116-3326
Phone
(801) 408-8654
NPI assigned
Jul 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 217465-1206 UT Primary

Addresses

Primary practice location

54 N 800 W
Salt Lake City, UT 84116-3326

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 408-8654

Other identifiers 1

IdentifierTypeStateIssuer
841401924005MedicaidUT

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
I20050217000286 UT Practitioner - Physician Assistant 6608828728 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

54 N 800
Salt Lake City, UT 84116-3326
Phone (801) 408-8654

700 S Hwy 99
Suite 3
Fillmore, UT 84631-5137
Phone (801) 357-4600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
217465-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc CurrentSince Nov 1, 2015 Accepting new patients
After Hours Medical LLC, Dba Medallus Medical CurrentSince Jul 29, 2013 Accepting new patients
After Hours Medical LLC CurrentSince Jul 29, 2013 Accepting new patients
Ihc Health Services, Inc. CurrentSince Nov 1, 2015 Accepting new patients
Gregory P. Dupont MD Past Accepting new patients
University Health Care Quick Clinic Physician Assistant Past Accepting new patients
University Primary Care Sports Med Past Accepting new patients
Senior Mobile Docs PastSince Nov 1, 2013 Accepting new patients

Locations

1126 E Draper Pkwy
Draper, UT 84020
Phone (801) 545-0600

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

54 N 8th W
Salt Lake City, UT 84116
Phone (801) 359-0901

Organizations & group practices 9

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463011200000",
    "number": "1528099710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-408-8654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 N 800 W",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841163326",
            "telephone_number": "801-408-8654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COBB",
        "first_name": "MATTHEW",
        "middle_name": "STEVEN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2016-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "217465-1206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "841401924005",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.