NPIMap

Organization Active NPI

Craig K. Matheson, D.O., P.L.L.C.

Doing business as Third Coast Family Practice

  • Primary Care Clinic/Center
  • Scottville, MI
National Provider Identifier
1205961745
Registry record updated Feb 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
5101011416 Issued in MI
Legal business name
CRAIG K. MATHESON, D.O., P.L.L.C.
Doing business as
Third Coast Family Practice
Practice address
821 W US Highway 10 31
Scottville, MI 49454-9601
Phone
(231) 757-2500
Fax
(231) 757-9073
NPI assigned
Feb 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2021

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

Authorized official

Name
Dr. Craig Kenneth Matheson, D.O.NPI 1699763953
Title
Owner and Sole Member
Phone
(231) 757-2500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 5101011416 MI Primary

Addresses

Primary practice location

821 W US Highway 10 31
Scottville, MI 49454-9601

Mailing address

821 West U.S. Highway 10
Scottville, MI 49454
Phone (231) 757-2500

Other identifiers 3

IdentifierTypeStateIssuer
CLIAOtherMI23D1038209
4615194MedicaidMI
0855301234OtherMIBLUE CROSS BLUE SHIELD ID

Other names 1

  • Third Coast Family Practice Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://fhir.healow.com/FHIRServer/fhir/GICAAA/metadata

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613520000000",
    "number": "1205961745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 WEST U.S. HIGHWAY 10",
            "city": "SCOTTVILLE",
            "state": "MI",
            "postal_code": "49454",
            "telephone_number": "231-757-2500",
            "fax_number": "231-757-9073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 W US HIGHWAY 10 31",
            "city": "SCOTTVILLE",
            "state": "MI",
            "postal_code": "494549601",
            "telephone_number": "231-757-2500",
            "fax_number": "231-757-9073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRAIG K. MATHESON, D.O., P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A",
        "authorized_official_last_name": "MATHESON",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER AND SOLE MEMBER",
        "authorized_official_telephone_number": "231-757-2500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MI",
            "license": "5101011416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "23D1038209",
            "identifier": "CLIA",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4615194",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD ID",
            "identifier": "0855301234",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.healow.com/FHIRServer/fhir/GICAAA/metadata",
            "affiliation": "N",
            "address_1": "821 W US Highway 10 31",
            "city": "Scottville",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494549601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Third Coast Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Third Coast Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Scottville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; 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.