NPIMap

Individual provider Active NPI

Michael S Mattia, MD

  • Family Medicine Physician
  • Kalamazoo, MI
National Provider Identifier
1619536331
Registry record updated Aug 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
72256 Issued in MN
Practice address
1000 Oakland Dr
Kalamazoo, MI 49008-1282
Phone
(269) 349-2641
NPI assigned
Jun 6, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 72256 MN Primary
Student in an Organized Health Care Education/Training Program 390200000X 4351045469 MI

Addresses

Primary practice location

1000 Oakland Dr
Kalamazoo, MI 49008-1282

Mailing address

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20220830003353 MN Practitioner - Family PracticePractitioner - Hospitalist 7113251281 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Hospitalist
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Grand Itasca Clinic and HospitalGroup PAC ID 8123939550, 328 clinicians

Practice addresses (Care Compare)

1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone (218) 326-3401

Hospital & facility affiliations

  • Grand Itasca Clinic and Hospital Hospital, Grand Rapids, MN, CCN 240064
  • North Memorial Health Hospital Hospital, Robbinsdale, MN, CCN 240001
  • Essentia Health Deer River Hospital, Deer River, MN, CCN 241360

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Itasca Clinic and Hospital CurrentSince Aug 1, 2025 Accepting new patients
Grand Itasca Clinic and Hospital CurrentSince Aug 1, 2025 Accepting new patients
Range Regional Health Services CurrentSince Oct 1, 2025 Accepting new patients
Range Regional Health Services CurrentSince Oct 1, 2025 Accepting new patients
Essentia Health Virginia, LLC CurrentSince Jan 21, 2025 Accepting new patients
Deer River Healthcare Center, Inc. Past Accepting new patients

Locations

1601 Golf Course Rd
Grand Rapids, MN 55744
Phone (218) 326-3401

111 SE 3rd St
Grand Rapids, MN 55744
Phone (218) 326-3401

750 E 34th St
Hibbing, MN 55746
Phone (218) 262-3441

402 E Platt Ave
Nashwauk, MN 55769
Phone (218) 885-2858

901 9th St N
Virginia, MN 55792
Phone (218) 741-3340

Interoperability endpoints

  • Direct secure messaging: mmattia2676344@fairview.direct-ci.com

Organizations & group practices 6

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 10

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": "1559779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660694400000",
    "number": "1619536331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 OAKLAND DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490081282",
            "telephone_number": "269-349-2641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTIA",
        "first_name": "MICHAEL",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-06",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "72256",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4351045469",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.