NPIMap

Individual provider Active NPI

Clifford M Matushin, DO

  • Internal Medicine Physician
  • Princeton, MN
National Provider Identifier
1639143688
Registry record updated Jan 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
107306 Issued in MN
Practice address
919 Northland Dr
Princeton, MN 55371-2172
Phone
(763) 389-3344
NPI assigned
Feb 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2014

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 3575 SD
Internal Medicine Physician 207R00000X 107306 MN Primary

Addresses

Primary practice location

919 Northland Dr
Princeton, MN 55371-2172

Mailing address

919 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-3344

Other identifiers 3

IdentifierTypeStateIssuer
6002770MedicaidSD
107306OtherMNMINNESOTA LICENSE
3575OtherSDSTATE LICENSE

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
I20131213000744 MN Practitioner - Internal Medicine 2567569882 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

1440 Duckwood Dr
Eagan, MN 55122-1451
Phone (651) 406-8860

5200 Fairview Blvd
Wyoming, MN 55092-8013
Phone (651) 982-7000

911 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-3344

919 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-3344

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics CurrentSince Dec 1, 2020 Accepting new patients
Fairview Express Care CurrentSince Oct 1, 2020 Accepting new patients
Fairview Express Care CurrentSince Oct 1, 2020 Accepting new patients
Fairview Health Services Current Accepting new patients
Avera St Lukes Current Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Clinics CurrentSince Dec 1, 2020 Accepting new patients
Fairview Health Services CurrentSince Dec 13, 2013 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

400 Stinson Blvd
Fl 2
Minneapolis, MN 55413
Phone (612) 672-2203

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

919 Northland Dr
Princeton, MN 55371
Phone (763) 389-3344

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

305 S State St
Aberdeen, SD 57401
Phone (605) 229-3000

Interoperability endpoints

  • Direct secure messaging: cmatushin310714@fairview.direct-ci.com

Organizations & group practices 12

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 8

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": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389052800000",
    "number": "1639143688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 NORTHLAND DR",
            "city": "PRINCETON",
            "state": "MN",
            "postal_code": "553712172",
            "telephone_number": "763-389-3344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 NORTHLAND DR",
            "city": "PRINCETON",
            "state": "MN",
            "postal_code": "553712172",
            "telephone_number": "763-389-3344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATUSHIN",
        "first_name": "CLIFFORD",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2014-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SD",
            "license": "3575",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "107306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6002770",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA LICENSE",
            "identifier": "107306",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "3575",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Princeton, MN

Sources for this page

Verify at the official NPI Registry.