Matthew Steven Nienberg, PA
Individual provider Active NPI Physician Assistant · Fremont, OH
NPI 1063661189 · NPPES record last updated Nov 22, 2019
Key facts
- NPI
- 1063661189
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 50.002810 (OH)
- Practice address
- 715 S Taft Ave
Fremont, OH 43420-3237 - Phone
- (419) 334-6639
- Fax
- (419) 333-2793
- NPI assigned
- Sep 12, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 12
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Specialty Physicians of Blanchard Valley LLC
Memorial Hospital
Practice addresses (Care Compare)
139 Garau St
Bluffton, OH 45817-1027
Phone (419) 423-5492
1740 N Perry St
Ottawa, OH 45875-1173
1900 S Main St
Findlay, OH 45840-1214
310 S Cable Rd
Lima, OH 45805-3110
Phone (567) 712-7741
715 S Taft Ave
Fremont, OH 43420-3237
Phone (419) 332-7321
Hospital & facility affiliations
- Memorial Hospital
- Bluffton Hospital
- Mercy Health St Ritas Medical Center
- Lima Memorial Health System
Merit-based Incentive Payment System (MIPS)
- Final score
- 71.66 of 100
- Quality
- 52.4
- Promoting interoperability
- 84
- Improvement activities
- 40
- Cost
- 66.45
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090116000426 | OH | Practitioner - Physician Assistant | 0042373094 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50.002810 | OH | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital | Current |
Accepting new patients | |
| Memorial Hospital | Current |
Accepting new patients | |
| Blanchard Valley Regional Health Center | Current |
Accepting new patients | |
| Blanchard Valley Regional Health Center | Current |
Accepting new patients | |
| Phoenix Emergency Physicians of the Midwest LLC | Past | Accepting new patients | |
| Lima Memorial Joint Operating Company | Past | Accepting new patients | |
| Ohio Emergency Physicians LLC | Past | Accepting new patients | |
| MD Hogan LTD | Past | Accepting new patients | |
| Midwest Pain Treatment Center, LLC | Past | Accepting new patients | |
| CRB of Ohio, Inc | Past | Accepting new patients | |
| Observation Physicians of Northwest Ohio LLC | Past |
Accepting new patients |
Locations
139 Garau St
Bluffton, OH 45817
Phone (419) 358-9010
1900 S Main St
Fl 3
Findlay, OH 45840
Phone (419) 423-4500
1900 S Main St
Findlay, OH 45840
Phone (419) 423-4500
715 S Taft Ave
Fremont, OH 43420
Phone (419) 332-7321
1740 N Perry St
Ste D
Ottawa, OH 45875
Phone (419) 420-7304
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 50.002810 | OH | Yes |
Addresses
Primary practice location
715 S Taft Ave
Fremont, OH 43420-3237
Mailing address
715 S Taft Ave
Fremont, OH 43420-3237
Phone (419) 334-6661
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0071619 | Medicaid | OH |
NPI Registry JSON
{
"created_epoch": "1221177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574380800000",
"number": "1063661189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "715 S TAFT AVE",
"city": "FREMONT",
"state": "OH",
"postal_code": "434203237",
"telephone_number": "419-334-6661",
"fax_number": "419-334-6685"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 S TAFT AVE",
"city": "FREMONT",
"state": "OH",
"postal_code": "434203237",
"telephone_number": "419-334-6639",
"fax_number": "419-333-2793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIENBERG",
"first_name": "MATTHEW",
"middle_name": "STEVEN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-09-12",
"last_updated": "2019-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OH",
"license": "50.002810",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0071619",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fremont, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 22, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.