Active NPI
Philip Matich
- Family Medicine Physician
- Mussey, MI
National Provider Identifier
1275734394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- PM406642
- Practice address
- 4316 Capac Rd
Mussey, MI 48014-3108 - Phone
- (810) 395-4375
- NPI assigned
- May 29, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | PM406642 | MI | Primary |
Addresses
Primary practice location
4316 Capac Rd
Mussey, MI 48014-3108
Mailing address
4316 Capac Rd
Mussey, MI 48014-3108
Phone (810) 395-4375
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PM406642 | Other | MI | STATE LICENSE |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PM406642 | MI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Capac Medical Center P C | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Internal Medicine Physician
- Mussey, MI
- NPI 1144421959
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275734394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4316 CAPAC RD",
"city": "MUSSEY",
"state": "MI",
"postal_code": "480143108",
"telephone_number": "810-395-4375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4316 CAPAC RD",
"city": "MUSSEY",
"state": "MI",
"postal_code": "480143108",
"telephone_number": "810-395-4375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATICH",
"first_name": "PHILIP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "PM406642",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "PM406642",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mussey, MI
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.