Ted Matzen, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

42965 Issued in MN

Practice address

11600 State Ave
Brainerd, MN 56401-7306

Phone

(218) 330-7455

Fax

(218) 828-2663

NPI assigned

Dec 6, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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 and National Provider Directory roles.

• Community Behavioral Health Hospital-Baxter

  • Psychiatric Hospital
  • Baxter, MN
  • NPI 1487715033
  NPD (past)

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356400444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14241 GRAND OAKS DR",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258747",
            "telephone_number": "218-330-7455",
            "fax_number": "218-829-9141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11600 STATE AVE",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564017306",
            "telephone_number": "218-330-7455",
            "fax_number": "218-828-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATZEN",
        "first_name": "TED",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "42965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacia Martin
• Nicole Mason, MSW, LICSW
• Holley J. Mathieu, M.S.
• Susan Mary Mathison-Young, NURSE PRACTITIONER
• Jeffrey J Mattson, DDS
• Jonathan S Mayer, MS LPC
• Kendra Dee McAlpine
• Tara McCapes, MASSAGE THERAPIST
• Jaiden Wentz McCormick, OT
• Paul Joseph McCormick

• Psychiatry Physician in Brainerd, MN
• Providers in Brainerd, MN by specialty
• Psychiatry Physician in Minnesota

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.