NPIMap

Individual provider Active NPI

Katherine Thomas Fortenberry, PH.D.

  • Clinical Psychologist
  • Salt Lake City, UT
National Provider Identifier
1982902185
Registry record updated Oct 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
8106647-2501 Issued in UT
Practice address
375 Chipeta Way
Suite a
Salt Lake City, UT 84108-1260
Phone
(801) 587-3379
NPI assigned
Mar 11, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 28, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Health Psychologist 103TH0004X 50871 MS
Clinical Psychologist 103TC0700X 50871 MS
Health Psychologist 103TH0004X 8106647-2501 UT
Clinical Psychologist 103TC0700X 8106647-2501 UT Primary

Addresses

Primary practice location

375 Chipeta Way
Suite a
Salt Lake City, UT 84108-1260

Mailing address

375 Chipeta Way
Suite a
Salt Lake City, UT 84108-1260
Phone (801) 587-3379

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kfortenberry4030@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
I20120323000225 UT Practitioner - Clinical Psychologist 5496915787 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2009
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)

1525 W 2100
Salt Lake City, UT 84119-1407
Phone (801) 213-8841

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
8106647-2501UTMDClinical Psychologist
50871MSMDHealth Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services CurrentSince Apr 6, 2016 Accepting new patients
University of Utah Adult Services CurrentSince Apr 6, 2016 Accepting new patients
University of Utah Community Physicians Group CurrentSince Feb 10, 2015 Accepting new patients
University of Utah CurrentSince Jan 1, 2016 Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Behavioral Health Services Current Accepting new patients
University of Utah Community Physicians Group CurrentSince Feb 10, 2015 Accepting new patients
University of Utah Behavioral Health Services CurrentSince Jul 1, 2015 Accepting new patients
University of Utah CurrentSince Jan 1, 2016 Accepting new patients
University of Utah Behavioral Health Services CurrentSince Jul 1, 2015 Accepting new patients
University of Utah Community Physicians Group Current Accepting new patients
University Primary Care Sports Med Past Accepting new patients

Locations

1525 W 2100 S
Salt Lake City, UT 84119
Phone (801) 213-8841

555 Foothill Dr
Slc, UT 84112
Phone (801) 581-7589

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

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1299801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1982902185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 CHIPETA WAY",
            "address_2": "SUITE A",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081260",
            "telephone_number": "801-587-3379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 CHIPETA WAY",
            "address_2": "SUITE A",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081260",
            "telephone_number": "801-587-3379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTENBERRY",
        "first_name": "KATHERINE",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-11",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "MS",
            "license": "50871",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MS",
            "license": "50871",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "UT",
            "license": "8106647-2501",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "UT",
            "license": "8106647-2501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kfortenberry4030@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.