Jake Roger Matern, D.P.T

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

1551 Renaissance Towne Dr Ste 350
Bountiful, UT 84010-7674

Phone

(801) 295-3553

Fax

(801) 295-3599

NPI assigned

May 29, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Performance West Physical TherapyGroup PAC ID 4789649047, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Performance West Physical Therapy

  • Physical Therapist
  • Bountiful, UT
  • NPI 1720148240
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1559088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582675200000",
    "number": "1730747411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 RENAISSANCE TOWNE DR STE 350",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107674",
            "telephone_number": "801-295-3553",
            "fax_number": "801-295-3599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 RENAISSANCE TOWNE DR STE 350",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107674",
            "telephone_number": "801-295-3553",
            "fax_number": "801-295-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATERN",
        "first_name": "JAKE",
        "middle_name": "ROGER",
        "credential": "D.P.T",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-29",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ethan Maryon
• Lyle Beyer Mason, M.D.
• Brittney N Mast
• Master Opticians
• Brendan Matern
• Mackenzie Mattern
• Matthew S. Brinkerhoff, P.C.
• Landon Matthews, DMD
• Craig J. Mattinson, DDS
• Michael Steven Maudsley, PT

• Physical Therapist in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Physical Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.