NPIMap

Individual provider Active NPI

Matthew Nedwicki, PA-C

  • Physician Assistant
  • Detroit, MI
National Provider Identifier
1134520042
Registry record updated Jun 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601007113 Issued in MI
Practice address
4771 Michigan Ave
Detroit, MI 48210-3247
Phone
(313) 897-2600
Fax
(313) 897-2424
NPI assigned
Sep 10, 2014
Last updated
Jun 8, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2026

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 5601007113 MI Primary

Addresses

Primary practice location

4771 Michigan Ave
Detroit, MI 48210-3247

Mailing address

1416 Erickson Rd
Boyne City, MI 49712-9199
Phone (313) 618-6824

Other practice location 1

1619 Anderson Rd
Petoskey, MI 49770-9256
Phone (231) 417-6050

Other practice location 2

825 N Center Ave
Gaylord, MI 49735-1592
Phone (989) 731-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, UT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150902002096 MI Practitioner - Physician Assistant 3577879758 Reassigns benefits to 7 organizations
I20190520001062 UT Practitioner - Physician Assistant 3577879758 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1619 Anderson Rd
Petoskey, MI 49770-9256
Phone (231) 417-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.79 of 100Reported as group
Quality
79.33
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601007113MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Mar 18, 2019 Accepting new patients
Ihc Health Services Inc Family Medicine CurrentSince Mar 18, 2019 Accepting new patients
Bay Street Orthopaedics PLLC CurrentSince Jul 1, 2019 Accepting new patients

Locations

14700 Lake Shore Dr
Charlevoix, MI 49720
Phone (231) 547-3840

4048 Cedar Bluff Dr
Ste 1
Petoskey, MI 49770
Phone (231) 347-5155

416 Connable Ave
Petoskey, MI 49770
Phone (231) 487-4000

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

Organizations & group practices 11

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 3

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": "1410307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780876800000",
    "number": "1134520042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 ERICKSON RD",
            "city": "BOYNE CITY",
            "state": "MI",
            "postal_code": "497129199",
            "telephone_number": "313-618-6824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4771 MICHIGAN AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482103247",
            "telephone_number": "313-897-2600",
            "fax_number": "313-897-2424"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1619 Anderson Rd",
            "address_purpose": "LOCATION",
            "city": "Petoskey",
            "state": "MI",
            "postal_code": "497709256",
            "country_code": "US",
            "telephone_number": "231-417-6050",
            "fax_number": "231-213-8749",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "825 N Center Ave",
            "address_purpose": "LOCATION",
            "city": "Gaylord",
            "state": "MI",
            "postal_code": "497351592",
            "country_code": "US",
            "telephone_number": "989-731-2100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NEDWICKI",
        "first_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-10",
        "last_updated": "2026-06-08",
        "certification_date": "2026-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.