NPIMap

Individual provider Active NPI

Matthew Nicholas Kozicki, M.D.

  • Family Medicine Physician
  • Blakeslee, PA
National Provider Identifier
1124330410
Registry record updated Jul 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD449228 Issued in PA
Practice address
Route 940 and 115
Blakeslee, PA 18610
Phone
(570) 646-8745
NPI assigned
Jul 2, 2010
Last updated
Jul 28, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD449228 PA Primary

Addresses

Primary practice location

Route 940 and 115
Blakeslee, PA 18610

Mailing address

PO Box 40
Blakeslee, PA 18610-0040
Phone (570) 646-8745

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address matthew.kozicki.1@21771.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20131022000289 PA Practitioner - Family Practice 0749415123 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Commonwealth Physician Network LLCGroup PAC ID 2668696592, 63 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

4 E Main St
Nanticoke, PA 18634-1602
Phone (570) 735-7474

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.17 of 100Reported as apm
Quality
78.34
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Physician Network LLC Family Medicine CurrentSince Nov 15, 2023 Accepting new patients

Locations

610 Wyoming Ave
Kingston, PA 18704
Phone (570) 288-5441

610 Wyoming Ave
#2
Kingston, PA 18704
Phone (570) 714-1032

4 E Main St
Nanticoke, PA 18634
Phone (570) 258-3939

Interoperability endpoints

  • Direct secure messaging: matthew.kozicki.1@21771.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 55

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1278028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627430400000",
    "number": "1124330410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "BLAKESLEE",
            "state": "PA",
            "postal_code": "186100040",
            "telephone_number": "570-646-8745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ROUTE 940 AND 115",
            "city": "BLAKESLEE",
            "state": "PA",
            "postal_code": "18610",
            "telephone_number": "570-646-8745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZICKI",
        "first_name": "MATTHEW",
        "middle_name": "NICHOLAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-02",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD449228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "matthew.kozicki.1@21771.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "amr direct address",
            "address_1": "4 E Main St",
            "city": "Nanticoke",
            "state": "PA",
            "country_code": "US",
            "postal_code": "186341602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Blakeslee, PA

Sources for this page

Verify at the official NPI Registry.