Individual provider Active NPI

Matthew Vega, MD

  • Anatomic Pathology Physician
  • Indianapolis, IN
National Provider Identifier
1073172953
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology PhysicianTaxonomy code 207ZP0101X
License
01093022A Issued in IN
Practice address
350 W 11TH St
Indianapolis, IN 46202-4108
Phone
(317) 274-4806
NPI assigned
Jun 13, 2019
Last updated
Jun 24, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology Physician 207ZP0101X 01093022A IN Primary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 125.074913 IL

Addresses

Primary practice location

350 W 11TH St
Indianapolis, IN 46202-4108

Mailing address

635 Barnhill Dr
Indianapolis, IN 46202-5126
Phone (317) 274-4806

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250710002485 IL Practitioner - Pathology 0345680104 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Florida State University College of Medicine, 2019
Medicare assignment
May accept Medicare assignment
Group practices
University Pathology Diagnostics SCGroup PAC ID 1052692464, 17 clinicians

Practice addresses (Care Compare)

1653 W Congress Pkwy
Chicago, IL 60612-3833
Phone (312) 942-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125.074913ILMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Pathologists P C Anatomic Pathology & Clinical Pathology CurrentSince Jul 1, 2025 Accepting new patients
University Pathology Diagnostics SC Anatomic Pathology & Clinical Pathology CurrentSince Jul 1, 2025 Accepting new patients
Nourishing Direction Inc PastSince Jun 1, 2024 Accepting new patients

Locations

1653 W Congress Pkwy
Chicago, IL 60612
Phone (312) 942-3138

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

5700 Southwyck Blvd
Toledo, OH 43614

Organizations & group practices 3

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 4

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": "1560384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1073172953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 BARNHILL DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025126",
            "telephone_number": "317-274-4806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W 11TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462024108",
            "telephone_number": "317-274-4806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VEGA",
        "first_name": "MATTHEW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-13",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "IN",
            "license": "01093022A",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": "125.074913",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.