Individual provider Active NPI

Matthew Eric Dahl, MD

  • Otolaryngology Physician
  • Salt Lake City, UT
National Provider Identifier
1679666556
Registry record updated Sep 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
T2004015307 Issued in MO
Practice address
22 S 900 E
Salt Lake City, UT 84102-1307
Phone
(801) 328-2522
Fax
(801) 533-0589
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X T2004015307 MO Primary

Addresses

Primary practice location

22 S 900 E
Salt Lake City, UT 84102-1307

Mailing address

22 S 900 E
Salt Lake City, UT 84102-1307
Phone (801) 328-2522

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
I20090619000151 UT Practitioner - Otolaryngology 1456402171 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Tulane University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Intermountain Ear Nose and Throat Specialists LLCGroup PAC ID 8022901610, 25 clinicians

Practice addresses (Care Compare)

4063 W 12600
Riverton, UT 84096-7302
Phone (801) 328-2522

756 E 12200
Draper, UT 84020-9724
Phone (801) 328-2522

Merit-based Incentive Payment System (MIPS)

Final score
91.17 of 100Reported as apm
Quality
80.65
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
T2004015307MOMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Ear,Nose, and Throat Specialists LLC CurrentSince Jul 1, 2009 Accepting new patients

Locations

13825 S Redwood Rd
Ste 250
Bluffdale, UT 84065

756 E 12200 S
Draper, UT 84020
Phone (801) 833-0579

1820 Sidewinder Dr
Ste 110
Park City, UT 84060
Phone (435) 649-4106

4063 W 12600 S
Riverton, UT 84096
Phone (801) 495-4800

3738 S 900 E
Salt Lake Cty, UT 84106
Phone (801) 313-1955

4400 S 7th E
Ste 240
Salt Lake Cty, UT 84107
Phone (801) 264-4464

22 S 9th E
Slc, UT 84102
Phone (801) 328-7522

Interoperability endpoints

  • Direct secure messaging: entcenterslc.matthewdahl@138948.advancedmd-direct.com

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316044800000",
    "number": "1679666556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 S 900 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021307",
            "telephone_number": "801-328-2522",
            "fax_number": "801-533-0589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S 900 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021307",
            "telephone_number": "801-328-2522",
            "fax_number": "801-533-0589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAHL",
        "first_name": "MATTHEW",
        "middle_name": "ERIC",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2011-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MO",
            "license": "T2004015307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.