NPIMap

Individual provider Active NPI

Matthew J Kettman, MD

  • Family Medicine Physician
  • Waterloo, IA
National Provider Identifier
1245218882
Registry record updated Feb 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
33683 Issued in IA
Practice address
110 Plaza Cir Ste a
Waterloo, IA 50701-5139
Phone
(319) 236-7720
NPI assigned
Jan 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2022

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 33683 IA Primary

Addresses

Primary practice location

110 Plaza Cir Ste a
Waterloo, IA 50701-5139

Mailing address

PO Box 2758
Waterloo, IA 50704-2758
Phone (319) 235-5390

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address matthew.kettman@cvms.eclinicaldirectplus.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20100218000345 IA Practitioner - Family Practice 2365586039 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

110 Plaza Cir
Suite a
Waterloo, IA 50701-5139
Phone (319) 236-7720

1753 W Ridgeway Ave
Waterloo, IA 50701-4588

1825 Logan Ave
Waterloo, IA 50703-1916
Phone (319) 235-3941

4150 Kimball Ave
Waterloo, IA 50701-9086

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
33683IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cedar Valley Medical Specialists PC CurrentSince Sep 1, 2017 Accepting new patients
St Luke's Methodist Hospital Current Accepting new patients
Cedar Valley Medical Specialists PC Family Medicine CurrentSince Sep 1, 2017 Accepting new patients
Floyd County Memorial Hospital Commission Family Medicine Past Accepting new patients
Cedar Valley Medical Specialists PC Past Accepting new patients

Locations

104 Broadway Pl
Anamosa, IA 52205
Phone (319) 462-5817

1795 Highway 64 E
Anamosa, IA 52205
Phone (319) 462-6161

220 Southbrooke Dr
Waterloo, IA 50702
Phone (319) 236-7720

1753 W Ridgeway Ave
Ste 107
Waterloo, IA 50701
Phone (319) 833-5907

4150 Kimball Ave
Waterloo, IA 50701
Phone (319) 235-5390

110 Plaza Cir
Ste A
Waterloo, IA 50701
Phone (319) 236-7720

Interoperability endpoints

  • Direct secure messaging: mkettman108335@direct.unitypoint.org
  • Direct secure messaging: matthew.kettman@cvms.eclinicaldirectplus.com

Organizations & group practices 5

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 6

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": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645488000000",
    "number": "1245218882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2758",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507042758",
            "telephone_number": "319-235-5390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 PLAZA CIR STE A",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507015139",
            "telephone_number": "319-236-7720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTMAN",
        "first_name": "MATTHEW",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-04",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "33683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "matthew.kettman@cvms.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "CVMS",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "110 Plaza Cir Ste A",
            "city": "Waterloo",
            "state": "IA",
            "country_code": "US",
            "postal_code": "507015139",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

Verify at the official NPI Registry.