NPIMap

Individual provider Active NPI

Matthew C Petznick, DO

  • Family Medicine Physician
  • Sandusky, OH
National Provider Identifier
1841363447
Registry record updated Dec 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34.009690 Issued in OH
Practice address
2500 W Strub Rd
Suite 230
Sandusky, OH 44870-5390
Phone
(419) 625-1200
Fax
(419) 625-0624
NPI assigned
Nov 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34.009690 OH Primary

Addresses

Primary practice location

2500 W Strub Rd
Suite 230
Sandusky, OH 44870-5390

Mailing address

PO Box 378
Sandusky, OH 44871-0378
Phone (419) 609-1112

Other identifiers 1

IdentifierTypeStateIssuer
3007249MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20100218000077 OH Practitioner - Family Practice 6103960950 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio University, College of Osteopathic Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2500 W Strub Rd
Suite 230
Sandusky, OH 44870-5390
Phone (419) 626-6161

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34.009690OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Ohio Medical Specialists, LLC CurrentSince Jul 1, 2010 Accepting new patients
Northern Ohio Medical Specialists LLC Family Medicine CurrentSince Jul 1, 2010 Accepting new patients
Northern Ohio Medical Specialists, LLC Past Accepting new patients

Locations

3004 Hayes Ave
Sandusky, OH 44870
Phone (419) 625-2841

2500 W Strub Rd
Ste 230
Sandusky, OH 44870
Phone (419) 625-1200

Interoperability endpoints

  • Direct secure messaging: mpetznick20630@nomshealthcare.direct-ci.com

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 8

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": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513123200000",
    "number": "1841363447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 378",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448710378",
            "telephone_number": "419-609-1112",
            "fax_number": "419-609-1123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 W STRUB RD",
            "address_2": "SUITE 230",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448705390",
            "telephone_number": "419-625-1200",
            "fax_number": "419-625-0624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETZNICK",
        "first_name": "MATTHEW",
        "middle_name": "C",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2017-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34.009690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3007249",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandusky, OH

Sources for this page

Verify at the official NPI Registry.