Individual provider Active NPI

Matthew T Czerniak, PA-C

  • Physician Assistant
  • Racine, WI
National Provider Identifier
1104058528
Registry record updated Aug 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2489-023 Issued in WI
Practice address
3801 Spring St
Racine, WI 53405-1667
Phone
(262) 687-4479
NPI assigned
Aug 18, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2009

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 2489-023 WI Primary

Addresses

Primary practice location

3801 Spring St
Racine, WI 53405-1667

Mailing address

3805B Spring St
Suite #230
Racine, WI 53405-1641
Phone (262) 687-4479

Other identifiers 1

IdentifierTypeStateIssuer
2489-023OtherWIWISCONSIN LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090902000468 WI Practitioner - Physician Assistant 4789739327 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Radiology Wisconsin LLCGroup PAC ID 9537595533, 111 clinicians

Practice addresses (Care Compare)

10180 Washington Ave
Mount Pleasant, WI 53177-1604
Phone (414) 973-7830

12831 N Port Washington Rd
Mequon, WI 53097-2416
Phone (414) 973-7844

13111 N Port Washington Rd
Mequon, WI 53097-2416
Phone (262) 243-7300

Hospital & facility affiliations

  • Ascension Columbia St Marys Hospital Milwaukee Hospital, Milwaukee, WI, CCN 520051
  • Ascension All Saints Hospital Hospital, Racine, WI, CCN 520096

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2489-023WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Racine Emergency Physicians, S.C. Past Accepting new patients
EMS Observation, S.C. PastSince Jun 5, 2022 Accepting new patients

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1250553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250553600000",
    "number": "1104058528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3805B SPRING ST",
            "address_2": "SUITE #230",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534051641",
            "telephone_number": "262-687-4479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 SPRING ST",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534051667",
            "telephone_number": "262-687-4479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CZERNIAK",
        "first_name": "MATTHEW",
        "middle_name": "T",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-18",
        "last_updated": "2009-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2489-023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN LICENSE",
            "identifier": "2489-023",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Racine, WI

Sources for this page

Verify at the official NPI Registry.