Individual provider Active NPI

Matthew C Grothaus, M.D.

  • Orthopaedic Surgery Physician
  • Hicksville, OH
National Provider Identifier
1417978776
Registry record updated Aug 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
35087589 Issued in OH
Practice address
208 Columbus St
Hicksville, OH 43526
Phone
(419) 542-5669
Fax
(419) 542-5667
NPI assigned
Jul 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 35087589 OH Primary

Addresses

Primary practice location

208 Columbus St
Hicksville, OH 43526

Mailing address

208 Columbus St
Hicksville, OH 43526-1299
Phone (419) 542-5669

Other practice location 1

442 W High St
Bryan, OH 43506-1681
Phone (419) 636-4517 ext. 4444

Other identifiers 3

IdentifierTypeStateIssuer
2791331MedicaidOH
35-087589OtherOHLICENSE
P00453968OtherOHRAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, OH2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20061219000521 IN Practitioner - Orthopedic SurgeryPractitioner - Hand Surgery 9032118138 Reassigns benefits to 1 organization
I20071113000491 OH Practitioner - Orthopedic SurgeryPractitioner - General Surgery 9032118138 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Toledo Medical College, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians

Practice addresses (Care Compare)

1250 Ralston Ave
Suite 104
Defiance, OH 43512-5308
Phone (419) 783-7300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement23
Knee replacement48
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)32
Removal of tissue1-10
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
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

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Oct 17, 2023 Accepting new patients
Parkview Health System, Inc. Orthopaedic Surgery CurrentSince Apr 1, 2016 Accepting new patients
Promedica Central Physicians Orthopaedic Surgery CurrentSince Oct 17, 2023 Accepting new patients
Parkview Health System Inc Current Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

11109 Parkview Plaza Dr
Fort Wayne, IN 46845
Phone (260) 266-2020

3926 New Vision Dr
Fort Wayne, IN 46845
Phone (260) 266-8210

240 S Jefferson St
Ste B
Huntington, IN 46750
Phone (219) 259-0000

512 Professional Way
Kendallville, IN 46755
Phone (260) 347-8556

442 W High St
Bryan, OH 43506
Phone (260) 266-8210

1252 Ralston Ave
Ste 302
Defiance, OH 43512
Phone (419) 783-6996

1250 Ralston Ave
Ste 104
Defiance, OH 43512
Phone (419) 784-3044

208 Columbus St
Hicksville, OH 43526
Phone (419) 542-6692

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

Interoperability endpoints

  • Direct secure messaging: mgrothaus24697@direct.promedica.org

Organizations & group practices 5

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.

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": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534204800000",
    "number": "1417978776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 COLUMBUS ST",
            "city": "HICKSVILLE",
            "state": "OH",
            "postal_code": "435261299",
            "telephone_number": "419-542-5669",
            "fax_number": "419-542-5667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 COLUMBUS ST",
            "city": "HICKSVILLE",
            "state": "OH",
            "postal_code": "43526",
            "telephone_number": "419-542-5669",
            "fax_number": "419-542-5667"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "442 W High St",
            "address_purpose": "LOCATION",
            "city": "Bryan",
            "state": "OH",
            "postal_code": "435061681",
            "country_code": "US",
            "telephone_number": "419-636-4517 x4444",
            "fax_number": "419-636-6438",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GROTHAUS",
        "first_name": "MATTHEW",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2018-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "OH",
            "license": "35087589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2791331",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "35-087589",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00453968",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hicksville, OH

Sources for this page

Verify at the official NPI Registry.