Individual provider Active NPI

Matthew Kobeszko, M.D.

  • Gastroenterology Physician
  • Southlake, TX
National Provider Identifier
1619402658
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
V1812 Issued in TX
Practice address
505 S Nolen Dr Ste a
Southlake, TX 76092-9167
Phone
(817) 424-1525
NPI assigned
Apr 27, 2017
Last updated
Jul 30, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X V1812 TX Primary

Addresses

Primary practice location

505 S Nolen Dr Ste a
Southlake, TX 76092-9167

Mailing address

PO Box 35629
Dallas, TX 75235-0629
Phone (214) 424-2200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, TX2 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
I20230731000701 WI Practitioner - Gastroenterology 7911275474 Reassigns benefits to 1 organization
I20240807004651 TX Practitioner - Gastroenterology 7911275474 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
R Franklin University of Med & Sci/Chicago Medical School, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

505 S Nolen Dr
A
Southlake, TX 76092-9167
Phone (817) 424-1525

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.98 of 100Reported as group
Quality
66.51
Promoting interoperability
98
Improvement activities
40
Cost
71.76

Merit-based Incentive Payment System (MIPS)

Final score
85.73 of 100Reported as group
Quality
58.78
Promoting interoperability
95
Improvement activities
40
Cost
88.4

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy83
Upper gastrointestinal (GI) endoscopy for acid reflux390

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
V1812TXMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Digestive Disease Consultants, PLLC Gastroenterology Current Accepting new patients
Texas Digestive Disease Consultants PLLC Gastroenterology CurrentSince Jun 24, 2024 Accepting new patients
Ascension Medical Group-Southeast Wisconsin Inc CurrentSince Jul 10, 2023 Accepting new patients
Texas Digestive Disease Consultants, PLLC Gastroenterology CurrentSince Jun 24, 2024 Accepting new patients

Locations

601 S Main St
Keller, TX 76248
Phone (817) 741-4347

505 S Nolen Dr
#A
Southlake, TX 76092
Phone (817) 424-1525

505 S Nolen Dr
Ste A
Southlake, TX 76092
Phone (817) 424-1525

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

19333 W North Ave
Brookfield, WI 53045
Phone (262) 785-2000

9969 S 27th St
Franklin, WI 53132
Phone (414) 325-2229

3811 Spring St
Mount Pleasant, WI 53405
Phone (262) 687-1600

3811 Spring St
Ste 102
Mount Pleasant, WI 53405
Phone (262) 687-5800

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

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 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": "1493251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1619402658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35629",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752350629",
            "telephone_number": "214-424-2200",
            "fax_number": "214-231-2159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 S NOLEN DR STE A",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760929167",
            "telephone_number": "817-424-1525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOBESZKO",
        "first_name": "MATTHEW",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-27",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TX",
            "license": "V1812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

Verify at the official NPI Registry.