NPIMap

Individual provider Active NPI

Matthew William Lederer, DO

  • Family Medicine Physician
  • Clinton TWP, MI
National Provider Identifier
1417523481
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101028234 Issued in MI
Practice address
15855 19 Mile Rd
Clinton TWP, MI 48038-3504
Phone
(586) 263-2300
NPI assigned
Jun 1, 2021
Last updated
Aug 20, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 5101028234 MI Primary

Addresses

Primary practice location

15855 19 Mile Rd
Clinton TWP, MI 48038-3504

Mailing address

46300 White Cap Dr
Macomb, MI 48044-5731
Phone (586) 850-0137

Other practice location 1

5041 N Royal Dr
Traverse City, MI 49684-6986
Phone (231) 935-0600

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
I20240828000882 MI Practitioner - Family Practice 2264833607 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Munson Medical GroupGroup PAC ID 8820277015, 191 clinicians
Great Lakes Therapy Housecalls PCGroup PAC ID 7719876580, shared by 2 NPIs, 71 clinicians

Practice addresses (Care Compare)

5041 N Royal Dr
Traverse City, MI 49684-6986
Phone (231) 935-0600

9731 E Cherry Bend Rd
Traverse City, MI 49684-7621
Phone (231) 941-8100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.92
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Group CurrentSince Oct 1, 2024 Accepting new patients
Munson Medical Group Current Accepting new patients
Munson Medical Center Family Medicine Past Accepting new patients

Locations

2891 Momentum Pl
Chicago, IL 60689

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

1200 Sixth St
Ste 200
Traverse City, MI 49684

5041 N Royal Dr
Traverse City, MI 49684
Phone (231) 392-8400

Interoperability endpoints

  • Direct secure messaging: mlederer677796@direct.hfhs.org

Organizations & group practices 3

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": "1622505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1417523481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46300 WHITE CAP DR",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480445731",
            "telephone_number": "586-850-0137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15855 19 MILE RD",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480383504",
            "telephone_number": "586-263-2300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5041 N Royal Dr",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496846986",
            "country_code": "US",
            "telephone_number": "231-935-0600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEDERER",
        "first_name": "MATTHEW",
        "middle_name": "WILLIAM",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-01",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101028234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton TWP, MI

Sources for this page

Verify at the official NPI Registry.