Bruce Liron Matchin, DOCTOR OF OSTEOPATHY

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

2021016045 Issued in MO

Practice address

Captain James a. Lovell Federal Health Care Center
3001 Green Bay Road
North Chicago, IL 60064

Phone

(847) 688-1900

NPI assigned

Jul 9, 2008

Last updated

Oct 28, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1821251794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "8901 WISCONSIN AVENUE",
            "address_2": "NNMC - GME BUILDING 10 1ST FLOOR ROOM 1006",
            "city": "FPO",
            "state": "AA",
            "postal_code": "208895600",
            "telephone_number": "301-319-8278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CAPTAIN JAMES A. LOVELL FEDERAL HEALTH CARE CENTER",
            "address_2": "3001 GREEN BAY ROAD",
            "city": "NORTH CHICAGO",
            "state": "IL",
            "postal_code": "60064",
            "telephone_number": "847-688-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATCHIN",
        "first_name": "BRUCE",
        "middle_name": "LIRON",
        "name_prefix": "Dr.",
        "credential": "DOCTOR OF OSTEOPATHY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-09",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MO",
            "license": "2021016045",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas E. Martin, PSY.D., LCPC
• Eryn Martinez, OD
• Elizabeth Grace Mason, LCSW
• Karona Monica Mason, DPM
• Lillian Matanmi, CRNA
• Arun Mathew, PHARMD
• Joshua Dev Mathew, DDS, MPH
• Manjiri Miriam Mathew, PHARM D, BCPS
• Mintu Mathew, RN
• Anna Matyja

• Sports Medicine (Family Medicine) Physician in North Chicago, IL
• Providers in North Chicago, IL by specialty
• Sports Medicine (Family Medicine) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.