Individual provider Active NPI

Matthew R Noordsij-Jones, MD

  • Internal Medicine Physician
  • Dayton, OH
National Provider Identifier
1891911640
Registry record updated Jun 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
57.012055 Issued in OH
Practice address
2351 Stanley Ave
Dayton, OH 45404-1201
Phone
(937) 228-0990
NPI assigned
Apr 18, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 57.012055 OH Primary
Pediatrics Physician 208000000X 57.012055 OH

Addresses

Primary practice location

2351 Stanley Ave
Dayton, OH 45404-1201

Mailing address

1323 W 3Rd St
Dayton, OH 45402-6714

Other identifiers 1

IdentifierTypeStateIssuer
3062699MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100910000380 OH Practitioner - Internal MedicinePractitioner - Pediatric Medicine 4688799943 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Medical College of Wisconsin, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gem City Primary Care LLCGroup PAC ID 0446610943, 2 clinicians

Practice addresses (Care Compare)

118 W 1St St
Dayton, OH 45402-1150
Phone (937) 345-1436

Hospital & facility affiliations

  • Kettering Health Dayton Hospital, Dayton, OH, CCN 360133
  • Miami Valley Hospital Hospital, Dayton, OH, CCN 360051

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57.012055OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gem City Primary Care LLC Internal Medicine CurrentSince Feb 23, 2023 Accepting new patients

Locations

118 W 1st St
Ste 800
Dayton, OH 45402
Phone (937) 321-8698

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JAJADD/Endpoint/JAJADD

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.

Hospital & facility affiliations 2

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": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404086400000",
    "number": "1891911640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1323 W 3RD ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454026714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2351 STANLEY AVE",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454041201",
            "telephone_number": "937-228-0990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOORDSIJ-JONES",
        "first_name": "MATTHEW",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2014-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "57.012055",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "57.012055",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3062699",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.