NPIMap

Individual provider Active NPI

Matthew Elmo Jacobson

  • Addiction (Substance Use Disorder) Counselor
  • Moroni, UT
National Provider Identifier
1952672735
Registry record updated Jan 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Practice address
21360 N 1450 E
Moroni, UT 84646-0461
Phone
(435) 445-5200
Fax
(435) 445-5201
NPI assigned
Jan 25, 2012
Last updated
Jan 25, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 25, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU Primary

Addresses

Primary practice location

21360 N 1450 E
Moroni, UT 84646-0461

Mailing address

PO Box 461
Moroni, UT 84646-0461
Phone (435) 445-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Hills Residential Treatment Past Accepting new patients
Lighthouse Ranch Corporation Past Accepting new patients

Organizations & group practices 2

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": "1327449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327449600000",
    "number": "1952672735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 461",
            "city": "MORONI",
            "state": "UT",
            "postal_code": "846460461",
            "telephone_number": "435-445-5200",
            "fax_number": "435-445-5201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21360 N 1450 E",
            "city": "MORONI",
            "state": "UT",
            "postal_code": "846460461",
            "telephone_number": "435-445-5200",
            "fax_number": "435-445-5201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "MATTHEW",
        "middle_name": "ELMO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-25",
        "last_updated": "2012-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moroni, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.