NPIMap

Individual provider Active NPI

Matthew E Hiestand, MD

  • Internal Medicine Physician
  • Bolivar, OH
National Provider Identifier
1497723613
Registry record updated Feb 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35070029H Issued in OH
Practice address
10724 State Route 212 NE
Bolivar, OH 44612-8740
Phone
(330) 874-7165
Fax
(330) 874-7166
NPI assigned
Mar 14, 2006
Last updated
Feb 17, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2012

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 35070029H OH Primary
Pediatrics Physician 208000000X 35-070029 OH

Addresses

Primary practice location

10724 State Route 212 NE
Bolivar, OH 44612-8740

Mailing address

6046 Whipple Ave NW
North Canton, OH 44720-7616
Phone (330) 874-7165

Other identifiers 1

IdentifierTypeStateIssuer
2066473MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20100707000172 OH Practitioner - Internal MedicinePractitioner - Pediatric Medicine 6406987593 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Medical College of Ohio, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orrville Hospital FoundationGroup PAC ID 7911890546, 78 clinicians

Practice addresses (Care Compare)

10724 State Route 212 NE
Bolivar, OH 44612-8740
Phone (330) 874-7165

2600 6TH St SW
Canton, OH 44710-1702

832 S Main St
Orrville, OH 44667-2208
Phone (330) 682-3010

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35070029HOHMDInternal Medicine Physician
35-070029OHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orrville Hospital Foundation CurrentSince Jul 1, 2020 Accepting new patients
Orrville Hospital Foundation CurrentSince Jul 1, 2020 Accepting new patients
Orrville Hospital Foundation Past Accepting new patients
Orrville Hospital Foundation Past Accepting new patients

Locations

10724 State Route 212 NE
Bolivar, OH 44612
Phone (330) 874-7165

2600 6th St SW
Canton, OH 44710
Phone (330) 363-2180

832 S Main St
Orrville, OH 44667
Phone (330) 456-2695

Interoperability endpoints

  • Direct secure messaging: matthew.hiestand@direct.aultman.org

Organizations & group practices 4

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 5

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": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329436800000",
    "number": "1497723613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6046 WHIPPLE AVE NW",
            "city": "NORTH CANTON",
            "state": "OH",
            "postal_code": "447207616",
            "telephone_number": "330-874-7165",
            "fax_number": "330-874-7166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10724 STATE ROUTE 212 NE",
            "city": "BOLIVAR",
            "state": "OH",
            "postal_code": "446128740",
            "telephone_number": "330-874-7165",
            "fax_number": "330-874-7166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIESTAND",
        "first_name": "MATTHEW",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2012-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35070029H",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35-070029",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2066473",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolivar, OH

Sources for this page

Verify at the official NPI Registry.