NPIMap

Individual provider Active NPI

Matthew T Provencher, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Vail, CO
National Provider Identifier
1831162759
Registry record updated Mar 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
56291 Issued in CO
Practice address
181 W Meadow Dr
Suite 400
Vail, CO 81657-5242
Phone
(970) 476-1100
Fax
(970) 479-5835
NPI assigned
Feb 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 255099 MA
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 56291 CO Primary

Addresses

Primary practice location

181 W Meadow Dr
Suite 400
Vail, CO 81657-5242

Mailing address

181 W Meadow Dr
Suite 400
Vail, CO 81657-5242
Phone (970) 476-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20160411000072 CO Practitioner - Orthopedic SurgeryPractitioner - Sports Medicine 1052323045 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic SurgeryAlso: Sports Medicine
Education
Geisel School of Medicine at Dartmouth, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Steadman Clinic Professional LLCGroup PAC ID 7719876226, 77 clinicians
Select Physical Therapy of West Denver Limited PartnershipGroup PAC ID 6709771157, shared by 5 NPIs, 530 clinicians

Practice addresses (Care Compare)

181 W Meadow Dr
Suite 400
Vail, CO 81657-5058
Phone (970) 476-1100

4617 W 20TH St
Greeley, CO 80634-3207
Phone (970) 352-9022

Hospital & facility affiliations

  • Vail Health Hospital Hospital, Vail, CO, CCN 060096
  • Montrose Regional Health Hospital, Montrose, CO, CCN 060006
  • Community Hospital Hospital, Grand Junction, CO, CCN 060054
  • Uchealth Yampa Valley Medical Center Hospital, Steamboat Springs, CO, CCN 060049
  • Heart of the Rockies Regional Medical Center Hospital, Salida, CO, CCN 061322

Merit-based Incentive Payment System (MIPS)

Final score
75.69 of 100Reported as group
Quality
71.4
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
99.15 of 100Reported as group
Promoting interoperability
99
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
40.82 of 100Reported as group
Quality
9.1
Promoting interoperability
100
Improvement activities
0
Cost
43.64

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)19
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56291COMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Steadman Clinic Professional LLC Sports Medicine CurrentSince Mar 7, 2016 Accepting new patients
Steadman Clinic Professional LLC Sports Medicine CurrentSince Mar 7, 2016 Accepting new patients
Midwest Orthopaedics at Rush, LLC Past Accepting new patients

Locations

401 Castle Creek Rd
Ste 2100
Aspen, CO 81611
Phone (970) 544-1289

200 Robinson St
Ste C300
Basalt, CO 81621

322 Beard Creek Rd
Edwards, CO 81632
Phone (970) 569-7429

360 Peak One Dr
#340
Frisco, CO 80443
Phone (970) 668-6760

181 W Meadow Dr
Ste 400
Vail, CO 81657
Phone (970) 680-0795

Interoperability endpoints

  • Direct secure messaging: mprovencher@tsc.emadirect.md

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 11

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": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457308800000",
    "number": "1831162759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "181 W MEADOW DR",
            "address_2": "SUITE 400",
            "city": "VAIL",
            "state": "CO",
            "postal_code": "816575242",
            "telephone_number": "970-476-1100",
            "fax_number": "970-479-5835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 W MEADOW DR",
            "address_2": "SUITE 400",
            "city": "VAIL",
            "state": "CO",
            "postal_code": "816575242",
            "telephone_number": "970-476-1100",
            "fax_number": "970-479-5835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCHER",
        "first_name": "MATTHEW",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2016-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "MA",
            "license": "255099",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CO",
            "license": "56291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vail, CO

Sources for this page

Verify at the official NPI Registry.