NPIMap

Individual provider Active NPI

R. Martin Matiscik, D.C

  • Radiology Chiropractor
  • Boardman, OH
National Provider Identifier
1255402277
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology ChiropractorTaxonomy code 111NR0200X
License
2192 Issued in OH
Practice address
914 Trailwood Dr
Boardman, OH 44512-5007
Phone
(330) 758-6440
Fax
(330) 758-6990
NPI assigned
Nov 13, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Chiropractor 111NR0200X 2192 OH Primary

Addresses

Primary practice location

914 Trailwood Dr
Boardman, OH 44512-5007

Mailing address

914 Trailwood Dr
Boardman, OH 44512-5007
Phone (330) 758-6440

Other identifiers 4

IdentifierTypeStateIssuer
000000350553OtherOHANTHEM
0190270MedicaidOH
268261599010OtherOHMEDICAL MUTUAL
000000229020OtherOHANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Diagnostic & Rehabilitation Center Inc PastSince Mar 1, 1999 Accepting new patients
McKinney Pain and Wellness Center, PLLC PastSince Feb 8, 2010 Accepting new patients
Physicians Diagnostic & Rehabilitation Center of Warren in Radiology PastSince Jan 1, 2005 Accepting new patients

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": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255402277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 TRAILWOOD DR",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125007",
            "telephone_number": "330-758-6440",
            "fax_number": "330-758-6990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 TRAILWOOD DR",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125007",
            "telephone_number": "330-758-6440",
            "fax_number": "330-758-6990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATISCIK",
        "first_name": "R. MARTIN",
        "name_prefix": "Dr.",
        "credential": "D.C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0200X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Radiology",
            "state": "OH",
            "license": "2192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000350553",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0190270",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL MUTUAL",
            "identifier": "268261599010",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000229020",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.