Active NPI
Matthew Barrett Innes, M.D.
- Dermatology Physician
- Layton, UT
National Provider Identifier
1679952212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 11240952-1205
- Practice address
- 2121 N 1700 W
Layton, UT 84041-8803 - Phone
- (801) 773-4840
- Fax
- (801) 525-8151
- NPI assigned
- May 28, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 11240952-1205 | UT | Primary |
Addresses
Primary practice location
2121 N 1700 W
Layton, UT 84041-8803
Mailing address
PO Box 337
Layton, UT 84041-0337
Phone (801) 778-4840
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Dermatology
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2121 N 1700
Layton, UT 84041-8803
Phone (801) 773-4840
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 362 |
| Removal of nail tissue | 1-10 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 99 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11240952-1205 | UT | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tanner Memorial Clinic | Dermatology | Current | Accepting new patients |
| Tanner Memorial Clinic | Current | Accepting new patients | |
| Rosenberg Cooley Metcalf LC | Past | Accepting new patients |
Locations
425 S 100 W
Layton, UT 84041
Phone (801) 682-8708
Interoperability endpoints
- matthew.innes.p1@direct.tannerclinic.nextgenshare.com
Organizations & group practices 3
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.
-
- Multi-Specialty Clinic/Center
- Layton, UT
- NPI 1538951165
-
- Orthopaedic Surgery Physician
- Park City, UT
- NPI 1649374216
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655078400000",
"number": "1679952212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 337",
"city": "LAYTON",
"state": "UT",
"postal_code": "840410337",
"telephone_number": "801-778-4840",
"fax_number": "801-525-8151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 N 1700 W",
"city": "LAYTON",
"state": "UT",
"postal_code": "840418803",
"telephone_number": "801-773-4840",
"fax_number": "801-525-8151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INNES",
"first_name": "MATTHEW",
"middle_name": "BARRETT",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-05-28",
"last_updated": "2022-06-13",
"certification_date": "2022-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "UT",
"license": "11240952-1205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Layton, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.