Individual provider Active NPI

Courtney R Matkovich, CRNP

  • Nurse Practitioner
  • Erie, PA
National Provider Identifier
1942696521
Registry record updated Oct 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
SP014832 Issued in PA
Practice address
145 W 23Rd St Ste 202
Erie, PA 16502-2858
Phone
(814) 452-5081
Fax
(814) 452-7918
NPI assigned
Apr 10, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X SP014832 PA Primary

Addresses

Primary practice location

145 W 23Rd St Ste 202
Erie, PA 16502-2858

Mailing address

145 W 23Rd St Ste 202
Erie, PA 16502-2858
Phone (814) 452-5081

Other identifiers 1

IdentifierTypeStateIssuer
1030224520002MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cmatkovich190534@direct.ahn.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150819007223 PA Practitioner - Nurse Practitioner 7214242320 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2315 Myrtle St
Suite 290
Erie, PA 16502-4609
Phone (814) 879-6636

Merit-based Incentive Payment System (MIPS)

Final score
93.9 of 100Reported as apm
Quality
85.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP014832PAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Medical Education and Research Institute Inc CurrentSince Jul 1, 2015 Accepting new patients
Saint Vincent Medical Education and Research Institute Past Accepting new patients

Locations

155 E State St
Albion, PA 16401
Phone (814) 756-4917

153 E 13th St
Ste 1300
Erie, PA 16503
Phone (814) 452-5081

2315 Myrtle St
Ste 290
Erie, PA 16502
Phone (814) 454-1142

145 W 23rd St
Ste 202
Erie, PA 16502
Phone (814) 580-5600

Interoperability endpoints

  • Direct secure messaging: cmatkovich190534@direct.ahn.org

Organizations & group practices 2

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": "1428624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1942696521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 W 23RD ST STE 202",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022858",
            "telephone_number": "814-452-5081",
            "fax_number": "814-452-7918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 W 23RD ST STE 202",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022858",
            "telephone_number": "814-452-5081",
            "fax_number": "814-452-7918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATKOVICH",
        "first_name": "COURTNEY",
        "middle_name": "R",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-10",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP014832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1030224520002",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cmatkovich190534@direct.ahn.org",
            "affiliation": "N",
            "address_1": "145 W 23rd St Ste 202",
            "city": "Erie",
            "state": "PA",
            "country_code": "US",
            "postal_code": "165022858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.