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MATTHEW NICHOLAS OTTO TCADC
NPI 1053907634
Counselor in Lexington, KY

Active since December 17, 2020PECOS EnrolledAccepts Medicare Assignment
600 PERIMETER DR STE 125, LEXINGTON, KY 40517(866) 678-8123 Get Directions Write a Review

NPPES record last updated: June 24, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jun 24, 2024, Dec 17, 2020 (2 updates tracked since 2020).

About Matthew Nicholas Otto Tcadc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MATTHEW NICHOLAS OTTO TCADC (NPI 1053907634) is an individual counselor in Lexington, Kentucky, licensed in Kentucky (290511) and active in the NPI registry since December 2020. He is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1053907634
Entity TypeIndividualMale
Primary Taxonomy101Y00000X
Provider Legal NameMATTHEW NICHOLAS OTTOCredential: TCADC
Location Address600 PERIMETER DR STE 125Lexington, KY 40517-4296
Mailing Address761 Dawson Springs WayLexington, KY 40511-2315 · (928) 830-9476
Phone(866) 678-8123
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateDecember 17, 2020
Last NPPES UpdateJune 24, 20242 updates tracked since enumeration
NPPES CertifiedJune 24, 2024
✔ NPI 1053907634 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers
Taxonomy Code101Y00000X
License✔ Licensed in KY · 290511
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
600 PERIMETER DR STE 125, Lexington, KY 40517
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Matthew Nicholas Otto Tcadc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8628594025
PECOS Enrollment IDI20250506001101
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Matthew Otto reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Roaring Brook LLC
Same address
Rehabilitation, Substance Use Disorder
600 PERIMETER DR STE 125
Lexington, KY 40517
  • Reassigned Medicare billing, Kentucky enrollment
  • 6 clinicians in this Medicare group
NPI 1053934836 (866) 678-8123

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROARING BROOK LLC
Clinic/Center (Rehabilitation, Substance Use Disorder)
600 PERIMETER DR STE 125
LEXINGTON, KY 40517
Fayette County (866) 678-8123
MR. JARROD CHASE LCSW
Social Worker (Clinical)
600 PERIMETER DR STE 125
LEXINGTON, KY 40517
Fayette County (866) 678-8123
KELSEY HESS
Counselor (Professional)
600 PERIMETER DR STE 125
LEXINGTON, KY 40517
Fayette County (866) 678-8123

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Matthew Otto's NPI number?

The NPI number for Matthew Otto is 1053907634. It was assigned to this individual provider in the NPPES registry on December 17, 2020.

Where is Matthew Otto located?

Matthew Otto practices at 600 Perimeter Dr Ste 125, Lexington, KY 40517. The listed phone number is (866) 678-8123.

What is Matthew Otto's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

Is Matthew Otto enrolled in Medicare?

Yes. Matthew Otto is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Matthew Otto's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Matthew Otto reassigns Medicare benefits to Roaring Brook LLC (Lexington, KY). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Matthew Otto's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Matthew Otto was last updated on June 24, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.