NPIMap

Organization Active NPI

Matclinic Physicians Practice Group LLC

  • Addiction (Substance Use Disorder) Counselor
  • Dundalk, MD
National Provider Identifier
1801448360
Registry record updated May 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
MATCLINIC PHYSICIANS PRACTICE GROUP LLC
Practice address
40 S Dundalk Ave Ste 400
Dundalk, MD 21222-4273
Phone
(410) 220-0780
Fax
(410) 862-0150
NPI assigned
Jul 15, 2019
Last updated
May 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dan Reck
Title
Manager
Phone
(410) 220-0780

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU Primary
Mental Health Counselor 101YM0800X NU
Professional Counselor 101YP2500X NU

Addresses

Primary practice location

40 S Dundalk Ave Ste 400
Dundalk, MD 21222-4273

Mailing address

PO Box 9068
Baltimore, MD 21222-0768
Phone (410) 220-0720

Other identifiers 1

IdentifierTypeStateIssuer
561008701MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170808001490 MD Part B Supplier - Clinic/Group Practice 3274804349 Receives reassigned benefits from 50 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hagerstown, MD; Westminster, MD; Towson, MD; Salisbury, MD; Havre de Grace, MD; Dundalk, MD; Annapolis, MD

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Matclinic Physicians Practice Group LLC33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

Organizations that report the same tax identification number in the National Provider Directory.

View all 32

Locations

38 S Dundalk Ave
Ste A1
Dundalk, MD 21222
Phone (410) 220-0780

40 S Dundalk Ave
Ste 504
Dundalk, MD 21222
Phone (410) 220-0780

40 York Rd
Ste 201
Towson, MD 21204
Phone (410) 220-0780

Practitioners & affiliated clinicians

Practitioners 42

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 42

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652227200000",
    "number": "1801448360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9068",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212220768",
            "telephone_number": "410-220-0720",
            "fax_number": "410-862-0150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 S DUNDALK AVE STE 400",
            "city": "DUNDALK",
            "state": "MD",
            "postal_code": "212224273",
            "telephone_number": "410-220-0780",
            "fax_number": "410-862-0150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATCLINIC PHYSICIANS PRACTICE GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-15",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A",
        "authorized_official_last_name": "RECK",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "410-220-0780"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "561008701",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dundalk, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; 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.

Verify at the official NPI Registry.