NPIMap

Individual provider Active NPI

Matthew A Mazur, D.O.

  • Internal Medicine Physician
  • Gaylord, MI
National Provider Identifier
1376719781
Registry record updated Dec 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
510102814 Issued in MI
Practice address
829 N Center Ave
Suite 140
Gaylord, MI 49735-1595
Phone
(989) 731-7870
Fax
(989) 731-7837
NPI assigned
May 6, 2008
Last updated
Dec 23, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036119681 IL
Internal Medicine Physician 207R00000X 510102814 MI Primary

Addresses

Primary practice location

829 N Center Ave
Suite 140
Gaylord, MI 49735-1595

Mailing address

850 N Otsego Ave
Suite 1
Gaylord, MI 49735-1568
Phone (989) 731-7708

Other identifiers 3

IdentifierTypeStateIssuer
OF96004OtherMIMEDICARE GROUP NUMBER
2220936OtherILBCBS
1376719781 1MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address matthew.mazur@omhmedicalgroup.directbygreenway.com

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
I20140226000393 MI Practitioner - Internal Medicine 0345311262 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Arizona College of Osteopathic Medicine Mid Western University, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northsport Physical Therapy and Rehabilitation P CGroup PAC ID 5294902508, shared by 2 NPIs, 43 clinicians

Practice addresses (Care Compare)

1622 Dickerson Rd
Gaylord, MI 49735-9206

1996 Walden
Gaylord, MI 49735
Phone 51773141111

829 N Ctr Ave
Gaylord, MI 49735-1595
Phone (989) 731-7708

829 N Ctr Ave
Gaylord, MI 49735-1598

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
510102814MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Munson Healthcare Otsego Memorial Hospital CurrentSince Jan 20, 2014 Accepting new patients
Munson Healthcare Otsego Memorial Hospital CurrentSince Jan 20, 2014 Accepting new patients
Munson Healthcare Otsego Memorial Hospital Past Accepting new patients

Locations

825 N Center Ave
Gaylord, MI 49735
Phone (989) 731-2100

829 N Center Ave
Gaylord, MI 49735
Phone (989) 731-2100

829 N Center Ave
Ste 140
Gaylord, MI 49735
Phone (989) 731-7860

Interoperability endpoints

  • Direct secure messaging: matthew.mazur@omhmedicalgroup.directbygreenway.com
  • Direct secure messaging: mmazur@direct.mhc.net

Organizations & group practices 7

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 8

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": "1210032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608681600000",
    "number": "1376719781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 N OTSEGO AVE",
            "address_2": "SUITE 1",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351568",
            "telephone_number": "989-731-7708",
            "fax_number": "989-731-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 N CENTER AVE",
            "address_2": "SUITE 140",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351595",
            "telephone_number": "989-731-7870",
            "fax_number": "989-731-7837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZUR",
        "first_name": "MATTHEW",
        "middle_name": "A",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-06",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036119681",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "510102814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "OF96004",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2220936",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376719781 1",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "matthew.mazur@omhmedicalgroup.directbygreenway.com",
            "affiliation": "N",
            "address_1": "829 N Center Ave",
            "address_2": "Suite 140",
            "city": "Gaylord",
            "state": "MI",
            "country_code": "US",
            "postal_code": "497351595",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gaylord, MI

Sources for this page

Verify at the official NPI Registry.