Matthew A Ketelaar, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

28007 Issued in IA

Practice address

1970 E 53Rd St
Davenport, IA 52807-2710

Phone

(563) 359-3949

NPI assigned

Mar 24, 2006

Last updated

May 5, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Merit-based Incentive Payment System (MIPS)

Final score

92.11 of 100Reported as group

Quality

90.72

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Radiology Group PC SC

  • Diagnostic Radiology Physician
  • Davenport, IA
  • NPI 1073573994

  IL

  Medicare reassignment
• Genesis Health System

  dba Genesis Convenient Care Davenport

  • Clinic/Center
  • Davenport, IA
  • NPI 1205860400
  NPD (past)
• Genesis Health System

  dba Genesis Convenient Care Bettendorf

  • Clinic/Center
  • Bettendorf, IA
  • NPI 1497772008
  NPD (past)
• Genesis Health System

  dba Genesis Medical Center Dewitt

  • Critical Access Hospital
  • De Witt, IA
  • NPI 1649368523
  NPD (past)
• Radiology Group Imaging Center, L.L.C.

  • Diagnostic Radiology Physician
  • Davenport, IA
  • NPI 1790745982
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620172800000",
    "number": "1336109180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1970 E 53RD ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072710",
            "telephone_number": "563-359-3949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1970 E 53RD ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072710",
            "telephone_number": "563-359-3949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETELAAR",
        "first_name": "MATTHEW",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IA",
            "license": "28007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2096792",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IA RGPCSC",
            "identifier": "32281",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5096792",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MDC RGIC LLC",
            "identifier": "300132302",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IA RGIC LLC",
            "identifier": "06050",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MDC RGPCSC",
            "identifier": "300034141",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mketelaar@rgimaging.com",
            "affiliation": "N",
            "endpointDescription": "Radiology Group Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1970 E 53rd St",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "528072710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kerry Panozzo MD PC (Interventions in Pain Management LLC)
• Kelly W Kersten, P.T.
• Todd M Kersten, P.T.
• Thomas Edward Kersting, DDS
• Sara Pierce Kessinger, TLMHC
• Morgan Cobie Ketner, LISW
• Kevin D. Hamilton, DC
• Kevin Hamilton DC-PC
• Kevin Swanon, PT P.C. (Plaza Physical Therapy)
• Kathleen J Keyes, M.D.

• Diagnostic Radiology Physician in Davenport, IA
• Providers in Davenport, IA by specialty
• Diagnostic Radiology Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; 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.

Verify at the official NPI Registry.