NPIMap

Individual provider Active NPI

Matthew Woolley, PHD

  • Clinical Psychologist
  • Salt Lake City, UT
National Provider Identifier
1871691956
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3458522501 Issued in UT
Practice address
650 Komas Dr
#208
Salt Lake City, UT 84108-1215
Phone
(801) 585-1212
Fax
(801) 585-9096
NPI assigned
Sep 20, 2006
Last updated
Dec 20, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 3458522501 UT Primary

Addresses

Primary practice location

650 Komas Dr
#208
Salt Lake City, UT 84108-1215

Mailing address

420 Chelsea Dr
Bountiful, UT 84010-4404

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mwoolley56249@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
I20050802000295 UT Practitioner - Clinical Psychologist 8729016639 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
3458522501UTMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Pediatric Behavioral Health Services CurrentSince Nov 1, 2016 Accepting new patients
University of Utah Pediatric Behavioral Health Services CurrentSince Nov 1, 2016 Accepting new patients
University of Utah Pediatric Behavioral Health Services Current Accepting new patients
University of Utah Behavioral Health Services CurrentSince Jul 1, 2015 Accepting new patients
University of Utah Behavioral Health Services Current Accepting new patients
University of Utah Behavioral Health Services CurrentSince Jul 1, 2015 Accepting new patients

Locations

525 E 100 S
Ste 500
Salt Lake City, UT 84102
Phone (801) 585-1212

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

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

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1871691956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 CHELSEA DR",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840104404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 KOMAS DR",
            "address_2": "#208",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081215",
            "telephone_number": "801-585-1212",
            "fax_number": "801-585-9096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOLLEY",
        "first_name": "MATTHEW",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "UT",
            "license": "3458522501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwoolley56249@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 Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.