Matthew Oldenburg

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

001082825 Issued in IL

Practice address

14880 Old Colonial Rd
Bloomington, IL 61705-5981

Phone

(309) 828-4641

NPI assigned

Mar 25, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Bloomington Township Fire Protection District

  • Land Ambulance
  • Bloomington, IL
  • NPI 1609069202
  NPD (past)

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

{
    "created_epoch": "1711324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1164272142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15817 OLD ORCHARD RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617055524",
            "telephone_number": "309-287-9157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14880 OLD COLONIAL RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617055981",
            "telephone_number": "309-828-4641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLDENBURG",
        "first_name": "MATTHEW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-03-25",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IL",
            "license": "001082825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Obstetrics and Gynecology Care Associates, S.C.
• Thomas C Ocheltree, M.D.
• Thomas Charles Ocheltree Jr., DMD
• Annabelle L Ogerio, PT
• Bamidele Ogunleye, M.D.
• Oncology Hematology Associates of Central Illinois (Illinois Cancer Care)
• Oneopto Il 2 PLLC (All About Eyes)
• Basha Ontiveros, M.S., CCC-SLP
• Yaw Opoku-Agyemang, APN
• Optim Dental Bloomington LLC

• Emergency Medical Services (Emergency Medicine) Physician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Emergency Medical Services (Emergency Medicine) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.