Individual provider Active NPI

Matthew Ryan Herron, M.D.

  • Emergency Medicine Physician
  • Canon City, CO
National Provider Identifier
1275783722
Registry record updated Sep 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
47886 Issued in CO
Practice address
1338 Phay Ave
Canon City, CO 81212-2302
Phone
(419) 350-7755
NPI assigned
Sep 22, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 7, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MT189327 PA
Emergency Medicine Physician 207P00000X 47886 CO Primary

Addresses

Primary practice location

1338 Phay Ave
Canon City, CO 81212-2302

Mailing address

5420 Backglen Dr
Colorado Springs, CO 80906-8600
Phone (419) 350-7755

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20130328000155 VA Practitioner - Emergency Medicine 0446305437 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Toledo College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Riverside Physician Services IncGroup PAC ID 5092608448, 793 clinicians

Practice addresses (Care Compare)

856 J Clyde Morris Blvd
Suite a
Newport News, VA 23601-1318
Phone (757) 316-5800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.91 of 100Reported as apm
Quality
92.86
Promoting interoperability
94.93
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
47886COMDEmergency Medicine Physician
MT189327PAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Physician Services Inc Emergency Medicine CurrentSince Apr 1, 2013 Accepting new patients
Riverside Physician Services Inc CurrentSince Apr 1, 2013 Accepting new patients
Riverside Physician Services Inc Current Accepting new patients
Integrity Urgent Care, P.C. Past Accepting new patients
Front Range Emergency Specialists, PC Emergency Medicine Past Accepting new patients
Riverside Physician Services, Inc. Emergency Medicine Past Accepting new patients
Trinidad Area Health Association Past Accepting new patients

Locations

7519 Hospital Dr
Gloucester, VA 23061
Phone (804) 693-8800

856 J Clyde Morris Blvd
Ste A
Newport News, VA 23601
Phone (757) 316-5900

500 J Clyde Morris Blvd
North North, VA 23601
Phone (757) 594-2000

1500 Commonwealth Ave
Williamsburg, VA 23185
Phone (757) 585-2200

Organizations & group practices 7

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 2

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": "1222041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315353600000",
    "number": "1275783722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5420 BACKGLEN DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809068600",
            "telephone_number": "419-350-7755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1338 PHAY AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812122302",
            "telephone_number": "419-350-7755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERRON",
        "first_name": "MATTHEW",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-22",
        "last_updated": "2011-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "MT189327",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "47886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canon City, CO

Sources for this page

Verify at the official NPI Registry.