Individual provider Active NPI

Matthew D Vincent, CRNA

  • Certified Registered Nurse Anesthetist
  • Hayward, WI
National Provider Identifier
1194007682
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
6231 Issued in WI
Practice address
11040 N State Road 77
Hayward, WI 54843-3606
Phone
(715) 934-4321
NPI assigned
Sep 12, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 6231 WI
Certified Registered Nurse Anesthetist 367500000X R1872253 MN
Certified Registered Nurse Anesthetist 367500000X 6231 WI Primary

Addresses

Primary practice location

11040 N State Road 77
Hayward, WI 54843-3606

Mailing address

11040 N State Road 77
Hayward, WI 54843-3606
Phone (715) 934-4321

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160617000476 WI Practitioner - Certified Registered Nurse Anesthetist (Crna) 5698949253 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Services, IncGroup PAC ID 9436061363, 32 clinicians

Practice addresses (Care Compare)

11040 N State Rd
Suite 77
Hayward, WI 54843-6391
Phone (715) 934-4245

Hospital & facility affiliations

  • Tamarack Health Hayward Medical Center Hospital, Hayward, WI, CCN 521336

Merit-based Incentive Payment System (MIPS)

Final score
86.19 of 100Reported as group
Quality
74.89
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
93.05 of 100Reported as group
Quality
87.37
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
6231WIMDNurse Practitioner
R1872253MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Services, Inc CurrentSince Jan 28, 2017 Accepting new patients
Memorial Medical Center Inc CurrentSince Feb 5, 2024 Accepting new patients
Medical Services, Inc CurrentSince Jan 28, 2017 Accepting new patients
Memorial Medical Center Inc CurrentSince Feb 5, 2024 Accepting new patients

Locations

1615 Maple Ln
Ashland, WI 54806
Phone (715) 682-4563

11040 N State Road 77
Hayward, WI 54843
Phone (715) 934-4244

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 1

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": "1315785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1194007682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11040 N STATE ROAD 77",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548433606",
            "telephone_number": "715-934-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11040 N STATE ROAD 77",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548433606",
            "telephone_number": "715-934-4321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINCENT",
        "first_name": "MATTHEW",
        "middle_name": "D",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-12",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "6231",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R1872253",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "6231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hayward, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; 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.