Andrea Jensen Matich, M.D.

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

6354383-1205 Issued in UT

Practice address

96 E Kimballs LN Ste 207
Draper, UT 84020-5021

Phone

(801) 576-2300

Fax

(844) 249-1746

NPI assigned

Sep 21, 2007

Last updated

Jan 20, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family PracticeAlso: Sports Medicine

Education

Saint Louis University School of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountainstar Specialty Services LLCGroup PAC ID 4688767551, 30 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lone Peak Hospital Hospital, Draper, UT, CCN 460060
• St Mark's Hospital Hospital, Salt Lake City, UT, CCN 460047

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mountainstar Specialty Services LLC

  • Surgery Physician
  • Salt Lake City, UT
  • NPI 1265638357
  Medicare reassignment Care Compare group NPD
• Mountainstar Medical Group-St. Marks Hospital, LLC

  • Family Medicine Physician
  • Salt Lake City, UT
  • NPI 1073795258
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lone Peak Hospital, Inc.

  dba Lone Peak Hospital

  • General Acute Care Hospital
  • Draper, UT
  • NPI 1770821571
  Care Compare affiliation
• Northern Utah Healthcare Corporation

  dba St. Mark's Hospital

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1164469243
  Care Compare affiliation

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

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579478400000",
    "number": "1902092133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100253",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303840253",
            "telephone_number": "801-568-5972",
            "fax_number": "844-249-1746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 E KIMBALLS LN STE 207",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840205021",
            "telephone_number": "801-576-2300",
            "fax_number": "844-249-1746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATICH",
        "first_name": "ANDREA",
        "middle_name": "JENSEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-21",
        "last_updated": "2020-01-20",
        "certification_date": "2020-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "UT",
            "license": "6354383-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265638357",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Marulanda
• Whitney Mascaro
• James Maska, PT, DPT
• David Alexander Matheson, CMHC
• Millie May Mathis, LMFT
• Jeffrey Matson, DC
• Laura Matson
• Morgan Matthews
• Claire Matzke
• Bailie Mauchley

• Sports Medicine (Family Medicine) Physician in Draper, UT
• Providers in Draper, UT by specialty
• Sports Medicine (Family Medicine) Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2020; 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.