NPIMap

Organization Active NPI

Matclinic Physicians Practice Group LLC

  • Clinical Medical Laboratory
  • Dundalk, MD
National Provider Identifier
1063904985
Registry record updated May 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
MATCLINIC PHYSICIANS PRACTICE GROUP LLC
Practice address
40 S Dundalk Ave Ste 400
Dundalk, MD 21222-4273
Phone
(410) 220-0780
Fax
(410) 862-0150
NPI assigned
Jun 6, 2018
Last updated
May 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2022

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

Authorized official

Name
Dan Reck
Title
Manager
Phone
(410) 220-0780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

40 S Dundalk Ave Ste 400
Dundalk, MD 21222-4273

Mailing address

PO Box 9068
Baltimore, MD 21222-0768
Phone (410) 220-0720

Other identifiers 1

IdentifierTypeStateIssuer
135675501MedicaidMD

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2139615Matclinic Physicians Practice Group, LLC40 S Dundalk Ave Suite 400, Dundalk, MD 21222Certificate of waiverNov 5, 2027
21D2142107Matclinic Physicians Practice Group40 S Dundalk Ave Suite 400, Dundalk, MD 21222AccreditationNov 19, 2026

National Provider Directory

National Provider Directory
Tax ID family
Matclinic Physicians Practice Group LLC33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

Organizations that report the same tax identification number in the National Provider Directory.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1528243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652227200000",
    "number": "1063904985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9068",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212220768",
            "telephone_number": "410-220-0720",
            "fax_number": "410-862-0150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 S DUNDALK AVE STE 400",
            "city": "DUNDALK",
            "state": "MD",
            "postal_code": "212224273",
            "telephone_number": "410-220-0780",
            "fax_number": "410-862-0150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATCLINIC PHYSICIANS PRACTICE GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-06",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A",
        "authorized_official_last_name": "RECK",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "410-220-0780"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135675501",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dundalk, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.