Individual provider Active NPI

Matthew E Wray, DC

  • Chiropractor
  • Clarkston, MI
National Provider Identifier
1043067192
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301401524 Issued in MI
Practice address
5855 Dixie Hwy
Clarkston, MI 48346-3395
Phone
(248) 599-7437
Fax
(248) 623-2049
NPI assigned
May 6, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2301401524 MI Primary

Addresses

Primary practice location

5855 Dixie Hwy
Clarkston, MI 48346-3395

Mailing address

9126 Softwater Woods Dr
Clarkston, MI 48348-4265
Phone (734) 474-9168

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240529002719 MI Practitioner - Chiropractic 2567804024 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clarkston Chiropractic Sports and Wellness LLCGroup PAC ID 6507097235, 2 clinicians

Practice addresses (Care Compare)

5855 Dixie Hwy
Clarkston, MI 48346-3395
Phone (248) 599-7455

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2301401524MIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Clarkston Chiropractic Sports & Wellness LLC Chiropractor CurrentSince Jun 3, 2024 Accepting new patients

Locations

5855 Dixie Hwy
Clarkston, MI 48346
Phone (248) 599-7455

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1714953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1043067192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9126 SOFTWATER WOODS DR",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483484265",
            "telephone_number": "734-474-9168",
            "fax_number": "248-623-2049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5855 DIXIE HWY",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483463395",
            "telephone_number": "248-599-7437",
            "fax_number": "248-623-2049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRAY",
        "first_name": "MATTHEW",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-06",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301401524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarkston, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.