Individual provider Active NPI

Matthew Glen Pridgeon, M.D.

  • Pediatrics Physician
  • Grand Rapids, MI
National Provider Identifier
1255642732
Registry record updated Jun 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301096898 Issued in MI
Practice address
35 Michigan St NE FL 2
Grand Rapids, MI 49503-2514
Phone
(616) 267-1925
Fax
(616) 267-1005
NPI assigned
Jun 29, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Hematology & Oncology Physician 2080P0207X 4301096898 MI
Pediatrics Physician 208000000X 4301096898 MI Primary

Addresses

Primary practice location

35 Michigan St NE FL 2
Grand Rapids, MI 49503-2514

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560
Phone (616) 486-6790

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mpridgeon19985@epic00.shdirect.org

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
I20131031000083 MI Practitioner - Pediatric MedicinePractitioner - Hematology/Oncology 8224263108 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301096898MIMDPediatric Hematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Health Hospitals Pediatric Hematology-Oncology CurrentSince Jun 1, 2017 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Nov 1, 2013 Accepting new patients
Spectrum Health Primary Care Partners Pediatric Hematology-Oncology Current Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Nov 1, 2013 Accepting new patients
Spectrum Health Hospitals CurrentSince Jun 1, 2017 Accepting new patients

Locations

35 Michigan St NE
Fl 2
Grand Rapids, MI 49503
Phone (616) 267-1925

100 Michigan St NE
#13
Grand Rapids, MI 49503
Phone (616) 267-0073

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

1110 Sixth St
Traverse City, MI 49684
Phone (231) 392-8400

Interoperability endpoints

  • Direct secure messaging: mpridgeon19985@epic00.corewelldirect.org
  • Direct secure messaging: mpridgeon19985@epic00.shdirect.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1277769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748995200000",
    "number": "1255642732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-486-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 MICHIGAN ST NE FL 2",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032514",
            "telephone_number": "616-267-1925",
            "fax_number": "616-267-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIDGEON",
        "first_name": "MATTHEW",
        "middle_name": "GLEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-29",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "MI",
            "license": "4301096898",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301096898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpridgeon19985@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "100 Michigan St NE",
            "address_2": "MC #13",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.