Matthew Adrian Jackman

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

447 Bearcat Dr
Salt Lake City, UT 84115-2519

Phone

(801) 355-2846

Fax

(801) 359-3244

NPI assigned

Nov 2, 2011

Sex

Male

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Senior Health Counseling Services LLCGroup PAC ID 2163962648, 4 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.

• Senior Health Counseling Services LLC

  • Clinical Social Worker
  • Woods Cross, UT
  • NPI 1073356945
  Medicare reassignment Care Compare group NPD
• Volunteers of America

  • Community/Behavioral Health Agency
  • Salt Lake City, UT
  • NPI 1598192338
  NPD (past)

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

{
    "created_epoch": "1320192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320192000000",
    "number": "1891071973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "447 BEARCAT DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841152519",
            "telephone_number": "801-355-2846",
            "fax_number": "801-359-3244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "447 BEARCAT DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841152519",
            "telephone_number": "801-355-2846",
            "fax_number": "801-359-3244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKMAN",
        "first_name": "MATTHEW",
        "middle_name": "ADRIAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-11-02",
        "last_updated": "2011-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ejay Jack, LCSW
• Heather Jack
• Abigail Brienn Jacketta, CST
• Danielle Marie Jacketta
• Julie Jackman
• Megan S Jackman, FNP-BC
• Sherry A Jackman
• Vicki L Jackman, APRN
• Stacey Jackson-Roberts, LCSW-C
• Alan E. Jackson, M.D.

• Addiction (Substance Use Disorder) Counselor in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Addiction (Substance Use Disorder) Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; 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.

Verify at the official NPI Registry.