NPIMap

Individual provider Active NPI

Igor Evan Matwijiw, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Texarkana, TX
National Provider Identifier
1114911369
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
J4910 Issued in TX
Practice address
2602 Saint Michael Dr Ste 201B
Texarkana, TX 75503-2320
Phone
(903) 614-5530
NPI assigned
Sep 2, 2005
Last updated
Jun 22, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X J4910 TX Primary

Addresses

Primary practice location

2602 Saint Michael Dr Ste 201B
Texarkana, TX 75503-2320

Mailing address

919 Hidden RDG
Irving, TX 75038-3813
Phone (469) 282-2711

Other practice location 1

2604 St Michael Dr
Ste 310
Texarkana, TX 75503-2373
Phone (903) 614-5530

Other identifiers 7

IdentifierTypeStateIssuer
126488906MedicaidTX
460002032OtherTXRAILROAD MEDICARE
4321815OtherTXAETNA
87281JOtherTXBCBS
87592ZOtherTXHMO BLUE
126488902MedicaidTX
200298690AMedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100805000679 TX Practitioner - Endocrinology 7911030309 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

2602 Saint Michael Dr
Suite 201B
Texarkana, TX 75503-2320
Phone (903) 614-5530

620 S Fleishel Ave
Christus Trinity Clinic
Tyler, TX 75701-2041
Phone (903) 606-4900

630 S Fleishel Ave
Tyler, TX 75701-2041
Phone (903) 606-5560

PO Box
Suite 846098
Dallas, TX 75284-6098

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas Endocrinology, Diabetes & Metabolism CurrentSince Jul 1, 2017 Accepting new patients
C H Wilkinson Physician Network CurrentSince Jul 1, 2010 Accepting new patients
C H Wilkinson Physician Network CurrentSince Jul 1, 2010 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jul 1, 2017 Accepting new patients
Christus Health Ark-la-Tex Past Accepting new patients
Integrated Infectious Diseases, PLLC PastSince Aug 1, 2009 Accepting new patients
Ozarks Medical Center Past Accepting new patients
Texas Gulf Coast Medical System, Inc Endocrinology, Diabetes & Metabolism Past Accepting new patients

Locations

3030 North St
Ste 420
Beaumont, TX 77702
Phone (409) 835-2900

919 Hidden Rdg
Irving, TX 75038

1276 S Peachtree St
Jasper, TX 75951
Phone (409) 384-5701

2602 Saint Michael Dr
Ste 201B
Texarkana, TX 75503
Phone (903) 614-5530

2604 Saint Michael Dr
Ste 310
Texarkana, TX 75503
Phone (903) 614-5050

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/996/brand/1/csg/213/fhir/r4
  • Direct secure messaging: imatwijiw226125@christushealth.direct-ci.net

Organizations & group practices 8

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 6

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": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1114911369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 HIDDEN RDG",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750383813",
            "telephone_number": "469-282-2711",
            "fax_number": "469-282-0996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2602 SAINT MICHAEL DR STE 201B",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032320",
            "telephone_number": "903-614-5530"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2604 St Michael Dr",
            "address_2": "Ste 310",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755032373",
            "country_code": "US",
            "telephone_number": "903-614-5530",
            "fax_number": "903-614-5535",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATWIJIW",
        "first_name": "IGOR",
        "middle_name": "EVAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-02",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "TX",
            "license": "J4910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126488906",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "460002032",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4321815",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "87281J",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMO BLUE",
            "identifier": "87592Z",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126488902",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200298690A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, TX

Sources for this page

Verify at the official NPI Registry.