Active NPI
Matthew McPherson, R.D.
- Registered Dietitian
- Carlinville, IL
National Provider Identifier
1639367535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164003834
- Practice address
- 20733 N. Broad St.
Carlinville, IL 62626-1499 - Phone
- (217) 854-3141
- NPI assigned
- Oct 5, 2007
- Last updated
- Oct 4, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164003834 | IL | Primary |
Addresses
Primary practice location
20733 N. Broad St.
Carlinville, IL 62626-1499
Mailing address
1400 Lynn St
Highland, IL 62249-2262
Phone (618) 698-9114
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111214000985 | IL | Practitioner - Registered Dietitian Or Nutrition Professional | 4284809542 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317686400000",
"number": "1639367535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 LYNN ST",
"city": "HIGHLAND",
"state": "IL",
"postal_code": "622492262",
"telephone_number": "618-698-9114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20733 N. BROAD ST.",
"city": "CARLINVILLE",
"state": "IL",
"postal_code": "626261499",
"telephone_number": "217-854-3141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCPHERSON",
"first_name": "MATTHEW",
"credential": "R.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-05",
"last_updated": "2011-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164003834",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carlinville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.