NPIMap

Individual provider Active NPI

Matthew Steven Nienberg, PA

  • Physician Assistant
  • Fremont, OH
National Provider Identifier
1063661189
Registry record updated Nov 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.002810 Issued in OH
Practice address
715 S Taft Ave
Fremont, OH 43420-3237
Phone
(419) 334-6639
Fax
(419) 333-2793
NPI assigned
Sep 12, 2008
Last updated
Nov 22, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.002810 OH Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20090116000426 OH Practitioner - Physician Assistant 0042373094 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Specialty Physicians of Blanchard Valley LLCGroup PAC ID 2668547613, 117 clinicians
Memorial HospitalGroup PAC ID 9739078528, 5 clinicians

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

Merit-based Incentive Payment System (MIPS)

Final score
71.66 of 100Reported as group
Quality
52.4
Promoting interoperability
84
Improvement activities
40
Cost
66.45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50.002810OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Blanchard Valley Regional Health Center CurrentSince Dec 1, 2011 Accepting new patients
Blanchard Valley Regional Health Center CurrentSince Dec 1, 2011 Accepting new patients
Memorial Hospital CurrentSince Jan 15, 2016 Accepting new patients
Memorial Hospital CurrentSince Jan 15, 2016 Accepting new patients
Midwest Pain Treatment Center, LLC Past 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
Observation Physicians of Northwest Ohio LLC PastSince Mar 21, 2021 Accepting new patients
MD Hogan LTD Past Accepting new patients
CRB of Ohio, Inc Past Accepting new patients

Locations

139 Garau St
Bluffton, OH 45817
Phone (419) 358-9010

1900 S Main St
Findlay, OH 45840
Phone (419) 423-4500

1900 S Main St
Fl 3
Findlay, OH 45840
Phone (419) 423-5555

715 S Taft Ave
Fremont, OH 43420
Phone (419) 332-7321

1740 N Perry St
Ste D
Ottawa, OH 45875
Phone (419) 420-7304

Organizations & group practices 12

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, OH

Sources for this page

Verify at the official NPI Registry.