Individual provider Active NPI

Matthew John Marr, D.C.

  • Chiropractor
  • Wadsworth, OH
National Provider Identifier
1184751869
Registry record updated Nov 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4093 Issued in OH
Practice address
201 Great Oaks TRL
Wadsworth, OH 44281-9430
Phone
(330) 336-9500
Fax
(330) 336-3377
NPI assigned
Feb 28, 2007
Last updated
Nov 23, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4093 OH Primary
Chiropractor 111N00000X DC009764 PA

Addresses

Primary practice location

201 Great Oaks TRL
Wadsworth, OH 44281-9430

Mailing address

201 Great Oaks TRL
Wadsworth, OH 44281-9430
Phone (330) 336-9500

Other identifiers 1

IdentifierTypeStateIssuer
0084598MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111103000847 OH Practitioner - Chiropractic 6305949066 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - West Sunnyvale, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Maximum Potential Chiropractic, Inc.Group PAC ID 7810925336, 4 clinicians

Practice addresses (Care Compare)

155 Northland Dr
Medina, OH 44256-1534
Phone (330) 723-1441

National Provider Directory

National Provider Directory
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.

State licenses

LicenseStateTypeSpecialty
4093OHMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lifesource Health Center LLC Chiropractor CurrentSince May 9, 2021 Accepting new patients
Maximum Potential Chiropractic, Inc. Chiropractor CurrentSince Jun 10, 2019 Accepting new patients
Maximum Potential Chiropractic Westlake, LLC Chiropractor CurrentSince Aug 6, 2019 Accepting new patients

Locations

155 Northland Dr
Medina, OH 44256
Phone (330) 723-1441

4483 Weymouth Rd
Medina, OH 44256
Phone (330) 764-3434

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479859200000",
    "number": "1184751869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 GREAT OAKS TRL",
            "city": "WADSWORTH",
            "state": "OH",
            "postal_code": "442819430",
            "telephone_number": "330-336-9500",
            "fax_number": "330-336-3377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 GREAT OAKS TRL",
            "city": "WADSWORTH",
            "state": "OH",
            "postal_code": "442819430",
            "telephone_number": "330-336-9500",
            "fax_number": "330-336-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARR",
        "first_name": "MATTHEW",
        "middle_name": "JOHN",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-28",
        "last_updated": "2016-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "4093",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC009764",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0084598",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wadsworth, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.