Active NPI
Matthew S. Kolkman, DDS
- Dentist
- Grabill, IN
National Provider Identifier
1255693396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12011830A
- Practice address
- 13307 Witmer Rd
Grabill, IN 46741-9636 - Phone
- (260) 627-1121
- NPI assigned
- Jun 14, 2012
- Last updated
- Jun 14, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12011830A | IN | Primary |
Addresses
Primary practice location
13307 Witmer Rd
Grabill, IN 46741-9636
Mailing address
10321 Garman Rd
Leo, IN 46765-9798
Phone (260) 241-4031
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130717000858 | IN | Order and Referring Only - Oral Surgery | 2466692348 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
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": "1339632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339632000000",
"number": "1255693396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10321 GARMAN RD",
"city": "LEO",
"state": "IN",
"postal_code": "467659798",
"telephone_number": "260-241-4031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13307 WITMER RD",
"city": "GRABILL",
"state": "IN",
"postal_code": "467419636",
"telephone_number": "260-627-1121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLKMAN",
"first_name": "MATTHEW",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-14",
"last_updated": "2012-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12011830A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grabill, IN
- Jerry Alvin Dearth, M.D.
- Michael Jon Duch, D.D.S.
- Grabill Eye Center LLC
- Brenda M Hoffman, PA-C
- Jordyn Marie Husted
- Kara Lynne Laughlin, O.D.
- MKD Dental Group (Grabill Family Dentistry)
- Northeast Allen County Fire & EMS, Inc.
- Northeast Allen County Fire and EMS Inc
- Northeast Allen Fire Protection District
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.