Matthew S Bodner, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

10657 Issued in AL

Practice address

5 Gilmer Pkwy
Suite 1
Tallassee, AL 36078-1215

Phone

(334) 731-4500

NPI assigned

Jul 17, 2006

Last updated

Sep 20, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

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.

• Montgomery Anesthesia Associates, PC

  • Anesthesiology Physician
  • Montgomery, AL
  • NPI 1043281553
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190246400000",
    "number": "1164449674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 GILMER PKWY",
            "address_2": "SUITE 1",
            "city": "TALLASSEE",
            "state": "AL",
            "postal_code": "360781215",
            "telephone_number": "334-731-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 GILMER PKWY",
            "address_2": "SUITE 1",
            "city": "TALLASSEE",
            "state": "AL",
            "postal_code": "360781215",
            "telephone_number": "334-731-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODNER",
        "first_name": "MATTHEW",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "R5J60",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AL",
            "license": "10657",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WI",
            "license": "50121-20",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202646105",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Irene Alam Bailey, MD
• Casey Mitchell Baynes, LPTA
• Thomas Deverell Bianchi, M.D.
• Bio-Medical Applications of Alabama, Inc. (Fresenius Medical Care Tallassee)
• Jared Merrill Blair, DPT
• Bonners Inc. (Bonners Medical Supply)
• Romesha Booker
• Tina Yankey Brooks, MED, ALC
• Valerie Michelle Brunson, M.S., BCBA
• Tyesha Keswana Butler

• Anesthesiology Physician in Tallassee, AL
• Providers in Tallassee, AL by specialty
• Anesthesiology Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2007; 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.