Active NPI
Melissa Matkovich
- Social Worker
- Southgate, MI
National Provider Identifier
1689125197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6801099384
- Practice address
- 13667 Eureka Rd
Southgate, MI 48195 - Phone
- (734) 530-6777
- NPI assigned
- Oct 19, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 6801099384 | MI | Primary |
Addresses
Primary practice location
13667 Eureka Rd
Southgate, MI 48195
Mailing address
13667 Eureka Rd
Southgate, MI 48195-1332
Phone (734) 530-6777
Other practice location 1
2051 W Grand Blvd
Detroit, MI 48208-1105
Phone (313) 961-3221
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Osh-Mi Physicians Group PC | Social Worker | Past | Accepting new patients |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529452800000",
"number": "1689125197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13667 EUREKA RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481951332",
"telephone_number": "734-530-6777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13667 EUREKA RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "48195",
"telephone_number": "734-530-6777"
}
],
"practiceLocations": [
{
"address_1": "2051 W Grand Blvd",
"address_purpose": "LOCATION",
"city": "Detroit",
"state": "MI",
"postal_code": "482081105",
"country_code": "US",
"telephone_number": "313-961-3221",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MATKOVICH",
"first_name": "MELISSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-19",
"last_updated": "2018-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6801099384",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.