Matthew Stark, MS, RDN, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164005802 Issued in IL

Practice address

2700 Dekalb Ave
Sycamore, IL 60178-3127

Phone

(815) 756-6174

NPI assigned

Aug 26, 2024

Last updated

Aug 26, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hy-Vee Health PCGroup PAC ID 1254701618, 43 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

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.

• Hy-Vee Health PC

  • Registered Dietitian
  • Chicago, IL
  • NPI 1629844568

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD
• Hy-Vee Health PC

  • Internal Medicine Physician
  • Omaha, NE
  • NPI 1184498990
  NPD
• Hy-Vee Health PC

  • Internal Medicine Physician
  • West Des Moines, IA
  • NPI 1558086637
  NPD (past)

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

{
    "created_epoch": "1724630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1073347852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 DEKALB AVE",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 DEKALB AVE",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783127",
            "telephone_number": "815-756-6174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "MATTHEW",
        "credential": "MS, RDN, LDN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-26",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164005802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kolawole Olufemi Dominik Sofowora, M.D.
• Haley Allyson Spengler
• Cheri Lynn Sprietler, NP APN
• Marcus Stammen, DO
• Ashli Stanfa, FNP-BC
• Bridget Starks, LMT
• Roger Stedman, PHARMD
• Jacob Stephen, M.D
• Bonnie Stewart-Henson, SLP
• Kathryn Stiltner, PHARMD

• Registered Dietitian in Sycamore, IL
• Providers in Sycamore, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.