Active NPI
Matthew Dommer, M.D.
- Emergency Medical Services (Emergency Medicine) Physician
- Kalamazoo, MI
National Provider Identifier
1891738852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medical Services (Emergency Medicine) Physician
- License
- 4301067676
- Practice address
- 125 S Kalamazoo Mall
Suite 204
Kalamazoo, MI 49007-4832 - Phone
- (269) 343-3900
- Fax
- (269) 343-5640
- NPI assigned
- Jun 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | 4301067676 | MI | Primary |
Addresses
Primary practice location
125 S Kalamazoo Mall
Suite 204
Kalamazoo, MI 49007-4832
Mailing address
125 S Kalamazoo Mall
Suite 204
Kalamazoo, MI 49007-4832
Phone (269) 343-3900
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10/4457925 | Medicaid | MI | |
| 10/4450423 | Medicaid | MI | |
| 104686919 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301067676 | MI | MD | Emergency Medical Services (Emergency Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bronson Methodist Hospital | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Hospitalist Physician
- Kalamazoo, MI
- NPI 1417961137
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269388800000",
"number": "1891738852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 S KALAMAZOO MALL",
"address_2": "SUITE 204",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490074832",
"telephone_number": "269-343-3900",
"fax_number": "269-343-5640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 S KALAMAZOO MALL",
"address_2": "SUITE 204",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490074832",
"telephone_number": "269-343-3900",
"fax_number": "269-343-5640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMMER",
"first_name": "MATTHEW",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2010-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "207PE0004X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Emergency Medical Services",
"state": "MI",
"license": "4301067676",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10/4457925",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10/4450423",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104686919",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kalamazoo, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.