Individual provider Active NPI

Matthew Paul Vasievich, M.D.

  • Dermatology Physician
  • Ann Arbor, MI
National Provider Identifier
1235576174
Registry record updated Nov 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
4301111784 Issued in MI
Practice address
4200 Whitehall Dr Ste 250
Ann Arbor, MI 48105-9694
Phone
(734) 677-3376
Fax
(734) 572-3229
NPI assigned
Jun 2, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Dermatology Physician 207N00000X 4301111784 MI Primary

Addresses

Primary practice location

4200 Whitehall Dr Ste 250
Ann Arbor, MI 48105-9694

Mailing address

3810 Central Pike
Hermitage, TN 37076-3494
Phone (815) 744-8554

Other practice location 1

9500 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-2200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170721001483 MI Practitioner - Dermatology 8426350554 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Michigan Medical School, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pinnacle Dermatology SCGroup PAC ID 8628353380, 145 clinicians

Practice addresses (Care Compare)

2433 Oak Valley Dr
Suite 400
Ann Arbor, MI 48103-7602
Phone (734) 477-0200

Hospital & facility affiliations

  • University of Michigan Health System Hospital, Ann Arbor, MI, CCN 230046

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision15
Removal of skin lesions870
Removal or shaving of skin growth17
Skin biopsy302

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301111784MIMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Audrey Bruell, M.D. P.C. Dermatology Current Accepting new patients
Iha Health Services Corporation Current Accepting new patients
Pinnacle Dermatology, SC CurrentSince Nov 27, 2022 Accepting new patients
Iha Health Service Corporation CurrentSince Jul 1, 2017 Accepting new patients
Iha Health Services Corporation CurrentSince Jul 1, 2017 Accepting new patients
Iha Health Services Corporation Past Accepting new patients

Locations

4200 Whitehall Dr
Ste 250
Ann Arbor, MI 48105
Phone (734) 622-5016

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

37605 Pembroke Ave
Livonia, MI 48152
Phone (734) 591-7931

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

3810 Central Pike
Hermitage, TN 37076

Interoperability endpoints

  • Direct secure messaging: mvasievich23810@direct.trinity-health.org

Organizations & group practices 7

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": "1370131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669075200000",
    "number": "1235576174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3810 CENTRAL PIKE",
            "city": "HERMITAGE",
            "state": "TN",
            "postal_code": "370763494",
            "telephone_number": "815-744-8554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 WHITEHALL DR STE 250",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059694",
            "telephone_number": "734-677-3376",
            "fax_number": "734-572-3229"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9500 Euclid Ave",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441950001",
            "country_code": "US",
            "telephone_number": "216-444-2200",
            "fax_number": "216-636-5830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VASIEVICH",
        "first_name": "MATTHEW",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-02",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301111784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.