NPIMap

Individual provider Active NPI

Matthew Kittle, DO

  • Family Medicine Physician
  • Ypsilanti, MI
National Provider Identifier
1316352396
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101021298 Issued in MI
Practice address
4940 W Clark Rd Ste 100
Ypsilanti, MI 48197-0860
Phone
(734) 971-1188
Fax
(734) 971-3658
NPI assigned
Jun 27, 2014
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 5101021298 MI
Family Medicine Physician 207Q00000X 5101021298 MI Primary

Addresses

Primary practice location

4940 W Clark Rd Ste 100
Ypsilanti, MI 48197-0860

Mailing address

4940 W Clark Rd Ste 100
Ypsilanti, MI 48197-0860
Phone (734) 971-1188

Other practice location 1

200 Arnet St
Suite 200
Ypsilanti, MI 48198-5753
Phone (734) 544-3220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170602000895 MI Practitioner - Family Practice 9032419940 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

4940 W Clark Rd
Suite 100
Ypsilanti, MI 48197-0860
Phone (734) 971-1188

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101021298MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Services Corporation Current Accepting new patients
Iha Health Service Corporation CurrentSince Jul 1, 2017 Accepting new patients
Iha Health Services Corporation CurrentSince Jul 1, 2017 Accepting new patients
Iha Health Services Corporation Family Medicine Past Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

1255 E M 36
Pinckney, MI 48169
Phone (734) 878-1000

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

4940 W Clark Rd
Ste 100
Ypsilanti, MI 48197
Phone (734) 434-0477

Interoperability endpoints

  • Direct secure messaging: mkittle25970@direct.trinity-health.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1403827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1316352396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4940 W CLARK RD STE 100",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481970860",
            "telephone_number": "734-971-1188",
            "fax_number": "734-971-3658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4940 W CLARK RD STE 100",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481970860",
            "telephone_number": "734-971-1188",
            "fax_number": "734-971-3658"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Arnet St",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Ypsilanti",
            "state": "MI",
            "postal_code": "481985753",
            "country_code": "US",
            "telephone_number": "734-544-3220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KITTLE",
        "first_name": "MATTHEW",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-27",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "5101021298",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101021298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.