Active NPI
Matthew C Wassom, PH.D.
- Clinical Psychologist
- Manhattan, KS
National Provider Identifier
1588998702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2036
- Practice address
- 1133 College Ave Ste G210
Manhattan, KS 66502-2709 - Phone
- (785) 537-3334
- NPI assigned
- Sep 21, 2009
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2036 | KS | Primary |
Addresses
Primary practice location
1133 College Ave Ste G210
Manhattan, KS 66502-2709
Mailing address
209 Fourwinds CT
Manhattan, KS 66503-3042
Phone (913) 486-6661
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210511001942 | KS | Practitioner - Psychologist Billing Independently | 1153730700 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756857600000",
"number": "1588998702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 FOURWINDS CT",
"city": "MANHATTAN",
"state": "KS",
"postal_code": "665033042",
"telephone_number": "913-486-6661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1133 COLLEGE AVE STE G210",
"city": "MANHATTAN",
"state": "KS",
"postal_code": "665022709",
"telephone_number": "785-537-3334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WASSOM",
"first_name": "MATTHEW",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-09-21",
"last_updated": "2025-09-03",
"certification_date": "2025-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KS",
"license": "2036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manhattan, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.