Active NPI
DRS Decheck and Mataczynski MD SC
- Family Medicine Physician
- Racine, WI
National Provider Identifier
1376614636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- DRS DECHECK AND MATACZYNSKI MD SC
- Practice address
- 3805 B Spring Street
Suite 250
Racine, WI 53405 - Phone
- (262) 634-6679
- Fax
- (262) 634-7935
- NPI assigned
- Nov 10, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Mark E Decheck, MD
- Title
- President
- Phone
- (262) 634-6679
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | WI | Primary |
Addresses
Primary practice location
3805 B Spring Street
Suite 250
Racine, WI 53405
Mailing address
3805B Spring St
Suite 250
Mount Pleasant, WI 53405-1641
Phone (262) 634-6679
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30593800 | Medicaid | WI | |
| 30772700 | Medicaid | WI | |
| 0000 90530 | Other | WI | MEDICARE NUMBER FOR CORPORATION |
| 25991 | Other | WI | LICENSE |
| 27946 | Other | WI | LICENSE |
National Provider Directory
National Provider DirectoryLocations
3805B Spring St
Ste 205
Mount Pleasant, WI 53405
Phone (262) 634-6679
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163116800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1429660800000",
"number": "1376614636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3805B SPRING ST",
"address_2": "SUITE 250",
"city": "MOUNT PLEASANT",
"state": "WI",
"postal_code": "534051641",
"telephone_number": "262-634-6679",
"fax_number": "262-634-7935"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3805 B SPRING STREET",
"address_2": "SUITE 250",
"city": "RACINE",
"state": "WI",
"postal_code": "53405",
"telephone_number": "262-634-6679",
"fax_number": "262-634-7935"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DRS DECHECK AND MATACZYNSKI MD SC",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-10",
"last_updated": "2015-04-22",
"status": "A",
"authorized_official_last_name": "DECHECK",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "262-634-6679",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "WI",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30593800",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30772700",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE NUMBER FOR CORPORATION",
"identifier": "0000 90530",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "25991",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "27946",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Racine, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.