Active NPI
Mark James Matthews, DDS
- General Practice Dentistry
- Tomah, WI
National Provider Identifier
1780799312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2482
- Practice address
- 214 Larkin St
Tomah, WI 54660-0606 - Phone
- (608) 372-3298
- Fax
- (608) 372-3128
- NPI assigned
- Aug 21, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2482 | WI | Primary |
Addresses
Primary practice location
214 Larkin St
Tomah, WI 54660-0606
Mailing address
PO Box 606
214 Larkin St
Tomah, WI 54660-0606
Phone (608) 372-3298
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 811742 | Other | UNITED CONCORDIA INS CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2013 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2482 | WI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Monroe | Past | Accepting new patients | |
| Tomah Family Dentistry LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Rolling Hills Rehabilitation Center
- Skilled Nursing Facility
- Sparta, WI
- NPI 1952306748
-
- General Practice Dentistry
- Tomah, WI
- NPI 1558476184
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372118400000",
"number": "1780799312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 606",
"address_2": "214 LARKIN ST",
"city": "TOMAH",
"state": "WI",
"postal_code": "546600606",
"telephone_number": "608-372-3298",
"fax_number": "608-372-3128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "214 LARKIN ST",
"city": "TOMAH",
"state": "WI",
"postal_code": "546600606",
"telephone_number": "608-372-3298",
"fax_number": "608-372-3128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTHEWS",
"first_name": "MARK",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-21",
"last_updated": "2013-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "2482",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA INS CO",
"identifier": "811742",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Tomah, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.