Individual provider Active NPI

Kevin Matrosic

  • Anesthesiology Physician
  • Holland, MI
National Provider Identifier
1609818400
Registry record updated Oct 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
4301073867 Issued in MI
Practice address
602 Michigan Ave
Holland, MI 49423-4918
Phone
(616) 392-5141
NPI assigned
Jun 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 4301073867 MI Primary

Addresses

Primary practice location

602 Michigan Ave
Holland, MI 49423-4918

Mailing address

3333 Evergreen Dr NE Ste 100
Grand Rapids, MI 49525-9493
Phone (616) 364-4200

Other practice location 1

8333 Felch St
Zeeland, MI 49464-2608
Phone (616) 364-4200

Other practice location 2

15100 Whittaker Way
Grand Haven, MI 49417-8696
Phone (616) 364-4200

Other practice location 3

3333 Evergreen Dr NE Ste 100
Grand Rapids, MI 49525-9493
Phone (616) 364-4200

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
I20101029000636 MI Practitioner - Anesthesiology 7113985821 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Michigan Medical School, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Macatawa Anesthesia PCGroup PAC ID 4183682883, 24 clinicians

Practice addresses (Care Compare)

602 Michigan Ave
Holland, MI 49423-4918
Phone (616) 392-5141

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301073867MIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Macatawa Anesthesia PC Anesthesiology CurrentSince Nov 1, 2003 Accepting new patients

Locations

602 Michigan Ave
Holland, MI 49423
Phone (616) 394-3350

Organizations & group practices 1

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 1

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": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729814400000",
    "number": "1609818400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 EVERGREEN DR NE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259493",
            "telephone_number": "616-364-4200",
            "fax_number": "616-364-7347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 MICHIGAN AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234918",
            "telephone_number": "616-392-5141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8333 Felch St",
            "address_purpose": "LOCATION",
            "city": "Zeeland",
            "state": "MI",
            "postal_code": "494642608",
            "country_code": "US",
            "telephone_number": "616-364-4200",
            "fax_number": "616-364-7347",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15100 Whittaker Way",
            "address_purpose": "LOCATION",
            "city": "Grand Haven",
            "state": "MI",
            "postal_code": "494178696",
            "country_code": "US",
            "telephone_number": "616-364-4200",
            "fax_number": "616-364-7347",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3333 Evergreen Dr NE Ste 100",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495259493",
            "country_code": "US",
            "telephone_number": "616-364-4200",
            "fax_number": "616-364-7347",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATROSIC",
        "first_name": "KEVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301073867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

Verify at the official NPI Registry.