Individual provider Active NPI

Matthew Ronald Jonovich, MD

  • Interventional Cardiology Physician
  • Jackson, MI
National Provider Identifier
1548378540
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
4301105307 Issued in MI
Practice address
309 Page Ave
Jackson, MI 49201-2419
Phone
(517) 787-1233
Fax
(517) 205-0150
NPI assigned
Aug 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 250004-1 NY
Cardiovascular Disease Physician 207RC0000X 4301105307 MI
Hospitalist Physician 208M00000X 250004-1 NY
Student in an Organized Health Care Education/Training Program 390200000X
Interventional Cardiology Physician 207RI0011X 4301105307 MI Primary

Addresses

Primary practice location

309 Page Ave
Jackson, MI 49201-2419

Mailing address

309 Page Ave
Jackson, MI 49201-2419
Phone (517) 787-1233

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cwillner365576@direct.hfhs.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20140617001831 MI Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 0749331163 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
Medical College of Ohio, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
W. a. Foote Memorial Hospital, Inc.Group PAC ID 0244136067, shared by 11 NPIs, 476 clinicians

Practice addresses (Care Compare)

2200 Springport Rd
Suite 240
Jackson, MI 49202-1432
Phone (517) 205-2107

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting49
Pacemaker insertion or repair1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
250004-1NYMDInternal Medicine Physician
4301105307MIMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Service Corporation CurrentSince Jul 1, 2014 Accepting new patients
Wa Foote Memorial Hospital Inc. Internal Medicine CurrentSince Jul 7, 2014 Accepting new patients
W.a. Foote Memorial Hospital, Inc Interventional Cardiology CurrentSince Sep 30, 2017 Accepting new patients
Iha Health Services Corporation Current Accepting new patients
Henry Ford Pathology Current Accepting new patients
W. a. Foote Memorial Hospital, Inc Internal Medicine Current Accepting new patients
Iha Health Services Organization Cardiovascular Disease CurrentSince Jul 1, 2014 Accepting new patients
W.a. Foote Memorial Hospital, Inc Cardiovascular Disease CurrentSince Jul 7, 2014 Accepting new patients
Wa Foote Memorial Hospital, Inc Current Accepting new patients
Wa Foote Memorial Hospital, Inc Past Accepting new patients
Internal Medicine at Lakeside Internal Medicine Past Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

7575 Grand River Rd
Ste 206
Brighton, MI 48114
Phone (810) 844-7750

49650 Cherry Hill Rd
Ste 120
Canton, MI 48187
Phone (734) 398-7800

14650 E Old US Highway 12
Chelsea, MI 48118
Phone (734) 475-2600

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

309 Page Ave
Jackson, MI 49201
Phone (517) 205-1234

2200 Springport Rd
Ste 240
Jackson, MI 49202
Phone (517) 205-2107

813 W Michigan Ave
Jackson, MI 49202
Phone (517) 205-1000

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

5325 Elliott Dr
Ypsilanti, MI 48197

Interoperability endpoints

  • Direct secure messaging: mjonovich451586@direct.hfhs.org

Organizations & group practices 11

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 2

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": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1548378540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 PAGE AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012419",
            "telephone_number": "517-787-1233",
            "fax_number": "517-205-0150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 PAGE AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012419",
            "telephone_number": "517-787-1233",
            "fax_number": "517-205-0150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONOVICH",
        "first_name": "MATTHEW",
        "middle_name": "RONALD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "250004-1",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "4301105307",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "250004-1",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MI",
            "license": "4301105307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwillner365576@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "2799 W Grand Blvd",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482022608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.