Matthew Hagan, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

M-15773 Issued in ID

Practice address

1855 Madison Ave
Idaho Falls, ID 83404-1212

Phone

(208) 881-5351

NPI assigned

Aug 12, 2012

Last updated

Jun 23, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in ID, PA2 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

Specialty

Plastic and Reconstructive Surgery

Education

Temple University School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Berks Plastic Surgery Institute PCGroup PAC ID 6305825902, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mhagan17955@uihealth.direct-ci.com
• Direct secure messaging: matthewhagan@bmh.medalliesdirect.net

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.

• Mark E Freeman M.D. PC

  dba Freeman Plastic Surgery

  • Plastic Surgery Physician
  • Idaho Falls, ID
  • NPI 1902228737
  Medicare reassignment NPD
• Berks Plastic Surgery Institute PC

  • Plastic Surgery Physician
  • Wyomissing, PA
  • NPI 1679695589
  Care Compare group
• BMH Inc

  • Critical Access Hospital
  • Blackfoot, ID
  • NPI 1982805271
  NPD
• BMH, Inc.

  dba Bingham Memorial Physicians & Surgeons Center

  • Surgery Physician
  • Blackfoot, ID
  • NPI 1255539193
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1477800134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3446",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834033446",
            "telephone_number": "208-552-8580",
            "fax_number": "208-523-2025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 MADISON AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834041212",
            "telephone_number": "208-881-5351"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3500 N Broad St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191404106",
            "country_code": "US",
            "telephone_number": "215-746-1018",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "820 S Wood St Ste 525",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606124325",
            "country_code": "US",
            "telephone_number": "312-996-9313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAGAN",
        "first_name": "MATTHEW",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-12",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036145857",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MT201381",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "ID",
            "license": "M-15773",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ID",
            "license": "M-15773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ritika Gupta
• Antonia Gutierrez Benitez, LPC
• Neal Boyd Guymon, O.D.
• Lourdes V Guzman, BA
• Hailey Guzzetti
• Jacklyn Hagg, AGACNP
• Lynetta Ruth Hagler, LCSW
• Avery Haile
• Hailey a. Clark FNP-C LLC
• Chelsey Jo Hale, LMSW

• Surgery Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.