Active NPI
Matthew Campbell Ericksen, D.O.
- Otolaryngology/Facial Plastic Surgery Physician
- Bolivar, MO
National Provider Identifier
1285956797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology/Facial Plastic Surgery Physician
- License
- 2012015105
- Practice address
- 1155 W Parkview St
Suite 2J
Bolivar, MO 65613-8279 - Phone
- (417) 328-7000
- NPI assigned
- Feb 25, 2010
- 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 |
|---|---|---|---|---|
| Otolaryngology/Facial Plastic Surgery Physician | 207YX0905X | 2012015105 | MO | Primary |
Addresses
Primary practice location
1155 W Parkview St
Suite 2J
Bolivar, MO 65613-8279
Mailing address
1801 SE Hillmoor Dr Ste B-105
Port St Lucie, FL 34952-7545
Phone (772) 398-9911
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | citizensmemorialhospital@mhccaremail.com | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220512002140 | FL | Practitioner - Otolaryngology | 0042525727 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Otolaryngology
- Education
- Arizona College of Osteopathic Medicine Mid Western University, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- ENT and Allergy Associates of Florida, LLC
Practice addresses (Care Compare)
1801 SE Hillmoor Dr
Suite B 105
Port St Lucie, FL 34952-7545
Phone (772) 398-9911
Hospital & facility affiliations
- St Lucie Medical Center
- HCA Florida Lawnwood Hospital
- Cleveland Clinic Martin North Hospital
- HCA Florida Raulerson Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
Practice roles (2 of 4)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| ENT and Allergy Associates of Florida, LLC | Current | Accepting new patients | |
| DRS Berghash & Lanza PL | Past | Accepting new patients |
Locations
6421 Congress Ave
Ste 113
Boca Raton, FL 33487
Phone (561) 338-3267
900 NW 13th St
Ste 206
Boca Raton, FL 33486
Phone (561) 338-3267
1801 SE Port St Lucie Blvd
Port St Lucie, FL 34952
Phone (772) 398-9911
1801 SE Hillmoor Dr
Ste B-105
Port St Lucie, FL 34952
Phone (561) 398-9911
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Organizations & group practices 2
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.
-
- Otolaryngology Physician
- Boca Raton, FL
- NPI 1164473120
FL
-
- Otolaryngology Physician
- Port St Lucie, FL
- NPI 1184681330
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Port St Lucie, FL
- NPI 1538115696
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1267056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733356800000",
"number": "1285956797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1801 SE HILLMOOR DR STE B-105",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349527545",
"telephone_number": "772-398-9911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1155 W PARKVIEW ST",
"address_2": "SUITE 2J",
"city": "BOLIVAR",
"state": "MO",
"postal_code": "656138279",
"telephone_number": "417-328-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERICKSEN",
"first_name": "MATTHEW",
"middle_name": "CAMPBELL",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-25",
"last_updated": "2024-12-05",
"certification_date": "2024-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "207YX0905X",
"taxonomy_group": "",
"desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
"state": "MO",
"license": "2012015105",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "citizensmemorialhospital@mhccaremail.com",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1155 W Parkview St",
"address_2": "Suite 2J",
"city": "Bolivar",
"state": "MO",
"country_code": "US",
"postal_code": "656138279",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bolivar, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.