NPIMap

Individual provider Active NPI

Matthew L Waack, MD

  • Diagnostic Radiology Physician
  • Grand Rapids, MI
National Provider Identifier
1831151802
Registry record updated Jun 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
4301073162 Issued in MI
Practice address
3264 N Evergreen Drive NE
Grand Rapids, MI 49525
Phone
(616) 363-7272
Fax
(616) 361-5828
NPI assigned
Apr 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 4301073162 MI Primary

Addresses

Primary practice location

3264 N Evergreen Drive NE
Grand Rapids, MI 49525

Mailing address

3264 N Evergreen Drive NE
Grand Rapids, MI 49525
Phone (616) 363-7272

Other identifiers 4

IdentifierTypeStateIssuer
G36004069OtherMIMEDICARE PTAN
4336465MedicaidMI
4336474MedicaidMI
P113493OtherBXBS MI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070507000089 MI Practitioner - Diagnostic Radiology 1355447400 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Wayne State University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Radiology Services PCGroup PAC ID 4284546516, 252 clinicians

Practice addresses (Care Compare)

700 Cooper Ave
Saginaw, MI 48602-5383
Phone (616) 363-7272

Hospital & facility affiliations

  • Mymichigan Medical Center Midland Hospital, Midland, MI, CCN 230222
  • Mymichigan Medical Center Alma Hospital, Alma, MI, CCN 230030
  • Mymichigan Medical Center Clare Hospital, Clare, MI, CCN 230180
  • Mymichigan Medical Center West Branch Hospital, West Branch, MI, CCN 230095
  • Mymichigan Medical Center Alpena Hospital, Alpena, MI, CCN 230036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301073162MIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Radiology Services PC Diagnostic Radiology CurrentSince Jan 1, 2022 Accepting new patients
Covenant Medical Center, Inc. CurrentSince Nov 28, 2010 Accepting new patients
Covenant Medical Center, Inc. Current Accepting new patients

Locations

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

3264 N Evergreen Dr NE
Grand Rapids, MI 49525
Phone (616) 391-6001

1447 N Harrison St
Saginaw, MI 48602
Phone (989) 583-4220

3400 N Center Rd
Ste 400
Saginaw, MI 48603
Phone (989) 799-5600

700 Cooper Ave
Saginaw, MI 48602
Phone (989) 583-6000

2463 S M 30
West Branch, MI 48661
Phone (517) 345-3660

Organizations & group practices 3

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 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1831151802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DRIVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49525",
            "telephone_number": "616-363-7272",
            "fax_number": "616-361-5828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DRIVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49525",
            "telephone_number": "616-363-7272",
            "fax_number": "616-361-5828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAACK",
        "first_name": "MATTHEW",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301073162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "G36004069",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4336465",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4336474",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BXBS MI",
            "identifier": "P113493",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.