NPIMap

Individual provider Active NPI

Mark Douglas Mottonen

  • Clinical Social Worker
  • S Salt Lake, UT
National Provider Identifier
1861653784
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
139850-3501 Issued in UT
Practice address
451 Bishop Federal LN
S Salt Lake, UT 84115-2357
Phone
(801) 487-7557
Fax
(801) 468-6838
NPI assigned
Jun 23, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 139850-3501 UT Primary

Addresses

Primary practice location

451 Bishop Federal LN
S Salt Lake, UT 84115-2357

Mailing address

451 Bishop Federal LN
S Salt Lake, UT 84115-2357
Phone (801) 487-7557

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmottonen89645@direct.med.utah.edu Direct UNIVERSITY OF UTAH

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
I20060107000085 UT Practitioner - Clinical Social Worker 2163445982 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Utah Behavioral Health ServicesGroup PAC ID 9537483607, 185 clinicians

Practice addresses (Care Compare)

525 E 100
Suite 500
Salt Lake City, UT 84102-4210
Phone (801) 585-2121

Merit-based Incentive Payment System (MIPS)

Final score
89.22 of 100Reported as group
Quality
83.74
Promoting interoperability
100
Improvement activities
40
Cost
66.87

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
139850-3501UTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Pediatric Behavioral Health Services CurrentSince Feb 4, 2017 Accepting new patients
University of Utah Pediatric Behavioral Health Services Current Accepting new patients
University of Utah Behavioral Health Services CurrentSince Feb 4, 2017 Accepting new patients
University of Utah Pediatric Behavioral Health Services CurrentSince Feb 4, 2017 Accepting new patients
University of Utah Behavioral Health Services CurrentSince Feb 4, 2017 Accepting new patients

Locations

525 E 100 S
Ste 500
Salt Lake City, UT 84102
Phone (801) 519-7190

501 S Chipeta Way
Slc, UT 84108
Phone (801) 581-7951

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Interoperability endpoints

  • Direct secure messaging: mmottonen89645@direct.med.utah.edu

Organizations & group practices 5

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": "1214179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1861653784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 BISHOP FEDERAL LN",
            "city": "S SALT LAKE",
            "state": "UT",
            "postal_code": "841152357",
            "telephone_number": "801-487-7557",
            "fax_number": "801-468-6838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 BISHOP FEDERAL LN",
            "city": "S SALT LAKE",
            "state": "UT",
            "postal_code": "841152357",
            "telephone_number": "801-487-7557",
            "fax_number": "801-468-6838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOTTONEN",
        "first_name": "MARK",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-23",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "139850-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmottonen89645@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "UNIVERSITY OF UTAH",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in S Salt Lake, UT

Sources for this page

Verify at the official NPI Registry.