Matthew A Mazur, D.O.
Individual provider Active NPI Internal Medicine Physician · Gaylord, MI
NPI 1376719781 · NPPES record last updated Dec 23, 2020
Key facts
- NPI
- 1376719781
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 510102814 (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
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 15
Hospital & facility affiliations 8
Medicare Care Compare profile
- 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 C
Munson Healthcare Otsego Memorial Hospital
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
- Munson Home Care
- Evergreen Home Health
- Residential Home Health and Hospice
- Compassus - Northern Michigan
- Munson Healthcare Otsego Memorial Hospital
- Munson Healthcare Grayling Hospital
- Munson Medical Center
- Charlevoix Area Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140226000393 | MI | Practitioner - Internal Medicine | 0345311262 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 510102814 | MI | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | 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 | 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 | Past | Accepting new patients |
Locations
829 N Center Ave
Ste 140
Gaylord, MI 49735
Phone (989) 731-7860
829 N Center Ave
Gaylord, MI 49735
Phone (989) 731-2100
825 N Center Ave
Gaylord, MI 49735
Phone (989) 731-2100
Interoperability endpoints
- matthew.mazur@omhmedicalgroup.directbygreenway.com
- mmazur@direct.mhc.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036119681 | IL | |
| Internal Medicine Physician | 207R00000X | 510102814 | MI | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2220936 | Other | IL | BCBS |
| 1376719781 1 | Medicaid | IL | |
| OF96004 | Other | MI | MEDICARE GROUP NUMBER |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | matthew.mazur@omhmedicalgroup.directbygreenway.com |
Other providers in Gaylord, MI
- Amber Maser
- Megan Marie Matelski
- Irineo C Matias
- Johanna Mauk
- Julia Mauldin
- Elizabeth Jean Mazzella
- Michelle McCarry
- Clorissa M McEachern
- McLaren Central Michigan
- Roxanne McLintock
All providers in Gaylord, MI · Internal Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.