Active NPI
Matthew Panicker, DO
- Internal Medicine Physician
- Mount Clemens, MI
National Provider Identifier
1639811151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 0102209431
- Practice address
- 1000 Harrington St
Mount Clemens, MI 48043-2920 - Phone
- (586) 493-8000
- NPI assigned
- Apr 13, 2022
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 0102209431 | VA | Primary |
Addresses
Primary practice location
1000 Harrington St
Mount Clemens, MI 48043-2920
Mailing address
1000 Harrington St
Mount Clemens, MI 48043-2920
Phone (586) 493-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251002002844 | VA | Practitioner - Emergency Medicine | 3072015619 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- Kansas City University of Med & Biosciences, College of Osteo Med, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Emergency Physicians of Tidewater
Practice addresses (Care Compare)
830 Kempsville Rd
Norfolk, VA 23502-3920
Phone (757) 466-6000
Hospital & facility affiliations
- Sentara Princess Anne Hospital
- Sentara Obici Hospital
- Sentara Leigh Hospital
- Sentara Norfolk General Hospital
- Sentara Virginia Beach General Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Physicians of Tidewater | Current | Accepting new patients |
Locations
830 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-6000
2800 Godwin Blvd
Suffolk, VA 23434
Phone (757) 363-6850
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 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Virginia Beach, VA
- NPI 1528028396
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784160000000",
"number": "1639811151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 HARRINGTON ST",
"city": "MOUNT CLEMENS",
"state": "MI",
"postal_code": "480432920",
"telephone_number": "586-493-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 HARRINGTON ST",
"city": "MOUNT CLEMENS",
"state": "MI",
"postal_code": "480432920",
"telephone_number": "586-493-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANICKER",
"first_name": "MATTHEW",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-13",
"last_updated": "2026-07-16",
"certification_date": "2026-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "VA",
"license": "0102209431",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Clemens, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.