Individual provider Active NPI

Matthew James Anderson, D.C.

  • Chiropractor
  • Bloomington, MN
National Provider Identifier
1891734380
Registry record updated Jul 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2928 Issued in MN
Practice address
10607 France Ave S
Bloomington, MN 55431-3539
Phone
(952) 881-5703
Fax
(952) 881-6871
NPI assigned
Jun 6, 2006
Last updated
Jul 27, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2928 MN Primary

Addresses

Primary practice location

10607 France Ave S
Bloomington, MN 55431-3539

Mailing address

10607 France Ave S
Bloomington, MN 55431-3539
Phone (952) 881-5703

Other identifiers 1

IdentifierTypeStateIssuer
258826900MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040119000128 MN Practitioner - Chiropractic 4183525827 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Los Angeles College of Chiropractic, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Back to Health Chiropractic PAGroup PAC ID 7719887165, 2 clinicians

Practice addresses (Care Compare)

10607 France S Ave
Bloomington, MN 55431-3539
Phone (952) 881-5703

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2928MNMDMental Health Counselor

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343347200000",
    "number": "1891734380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10607 FRANCE AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554313539",
            "telephone_number": "952-881-5703",
            "fax_number": "952-881-6871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10607 FRANCE AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554313539",
            "telephone_number": "952-881-5703",
            "fax_number": "952-881-6871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MATTHEW",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2012-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "2928",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "258826900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.