Individual provider Active NPI

Matthew D Hudson, D.D.S.

  • General Practice Dentistry
  • Grand Rapids, MI
National Provider Identifier
1083933725
Registry record updated May 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901020184 Issued in MI
Practice address
750 E Beltline Ave NE Ste 203
Grand Rapids, MI 49525-6046
Phone
(616) 957-4700
Fax
(616) 957-1605
NPI assigned
May 20, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901020184 MI Primary

Addresses

Primary practice location

750 E Beltline Ave NE Ste 203
Grand Rapids, MI 49525-6046

Mailing address

750 E Beltline Ave NE Ste 203
Grand Rapids, MI 49525-6046
Phone (616) 957-4700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150707000725 MI Order and Referring Only - DentistPractitioner - Dentist 4385956267

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901020184MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Matthew D. Hudson, D.D.S., P.C. General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1274313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274313600000",
    "number": "1083933725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 E BELTLINE AVE NE STE 203",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495256046",
            "telephone_number": "616-957-4700",
            "fax_number": "616-957-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E BELTLINE AVE NE STE 203",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495256046",
            "telephone_number": "616-957-4700",
            "fax_number": "616-957-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDSON",
        "first_name": "MATTHEW",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-20",
        "last_updated": "2010-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901020184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.