NPIMap

Individual provider Active NPI

Matthew Widmer, D.O.

  • Family Medicine Physician
  • Port Clinton, OH
National Provider Identifier
1174866164
Registry record updated Jun 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34-011496 Issued in OH
Practice address
3960 E Harbor Rd
Port Clinton, OH 43452
Phone
(419) 732-0700
Fax
(419) 732-0702
NPI assigned
Mar 28, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2018

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 34-011496 OH Primary

Addresses

Primary practice location

3960 E Harbor Rd
Port Clinton, OH 43452

Mailing address

1031 Pierce St
Sandusky, OH 44870-4669
Phone (419) 557-5541

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20150127000278 OH Practitioner - Family Practice 7719201565 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Coast Professional Company, LLCGroup PAC ID 6305810201, 105 clinicians

Practice addresses (Care Compare)

1470W McPherson Hwy
Clyde, OH 43410-1010
Phone (419) 547-0700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34-011496OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Firelands Regional Medical Center Current Accepting new patients
North Coast Professional Company, LLC Family Medicine CurrentSince Jan 6, 2014 Accepting new patients
North Coast Professional Company, LLC CurrentSince Jan 6, 2014 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

1470 W McPherson Hwy
Clyde, OH 43410
Phone (419) 547-0700

292 Benedict Ave
Norwalk, OH 44857
Phone (419) 663-3737

3960 East Harbor Rd
Port Clinton, OH 43452
Phone (419) 557-5488

703 Tyler St
Ste 352
Sandusky, OH 44870
Phone (419) 557-6785

2520 Columbus Ave
Ste F
Sandusky, OH 44870
Phone (567) 867-2520

1111 Hayes Ave
Sandusky, OH 44870
Phone (419) 557-7455

1031 Pierce St
Ste D
Sandusky, OH 44870

2800 Hayes Ave
Bldg E
Sandusky, OH 44870
Phone (419) 557-6817

1031 Pierce St
Sandusky, OH 44870
Phone (419) 557-5541

Interoperability endpoints

  • Direct secure messaging: matthew.widmer@fpg.medicity.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

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": "1364428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529280000000",
    "number": "1174866164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1031 PIERCE ST",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448704669",
            "telephone_number": "419-557-5541",
            "fax_number": "419-557-5542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3960 E HARBOR RD",
            "city": "PORT CLINTON",
            "state": "OH",
            "postal_code": "43452",
            "telephone_number": "419-732-0700",
            "fax_number": "419-732-0702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDMER",
        "first_name": "MATTHEW",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-28",
        "last_updated": "2018-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34-011496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Clinton, OH

Sources for this page

Verify at the official NPI Registry.