NPIMap

Individual provider Active NPI

Matthew J. Timm, MD

  • Family Medicine Physician
  • Pender, NE
National Provider Identifier
1952345167
Registry record updated May 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
22930 Issued in NE
Practice address
958 Wellness Way Ste 1
Pender, NE 68047-4518
Phone
(402) 385-3033
Fax
(402) 385-3092
NPI assigned
Jun 16, 2006
Last updated
May 5, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2020

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 22930 NE Primary

Addresses

Primary practice location

958 Wellness Way Ste 1
Pender, NE 68047-4518

Mailing address

PO Box 100
Pender, NE 68047-0100
Phone (402) 385-4004

Other identifiers 3

IdentifierTypeStateIssuer
4450726MedicaidIA
15966OtherNEBCBS NE
42128384911MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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
I20050112001134 NE Practitioner - Family PracticePractitioner - Emergency Medicine 1951359553 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nebraska College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 Hospital Dr
Pender, NE 68047-4507
Phone (402) 385-3083

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pender Community Hospital District Family Medicine CurrentSince Aug 9, 2008 Accepting new patients
Pender Community Hospital District Family Medicine Current Accepting new patients
Mercy Medical Services Family Medicine Past Accepting new patients
Pender Community Hospital District Family Medicine PastSince Aug 6, 2019 Accepting new patients
Pender Community Hospital District Family Medicine Past Accepting new patients
Pender Community Hospital District Past Accepting new patients
VSL Emerson LLC Past Accepting new patients

Locations

100 Hospital Dr
Pender, NE 68047
Phone (402) 385-3083

958 Wellness Way
Ste 1
Pender, NE 68047
Phone (402) 385-3033

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pender Community HospitalPender, NE, CCN 281349 Hospital W-2 Managing Employee
Operational/Managerial Control		 Feb 13, 2024
Feb 13, 2024
Pender Community HospitalPender, NE, CCN 28Z349 Hospital W-2 Managing Employee
Operational/Managerial Control		 Feb 13, 2024
Feb 13, 2024
Heritage of EmersonEmerson, NE, CCN 285222 Skilled nursing facility Contracted Managing Employee
Operational/Managerial Control		 Jul 1, 2017
Jul 1, 2017
Emerson Medical ClinicEmerson, NE, CCN 288525 Rural health clinic W-2 Managing Employee
Operational/Managerial Control		 Feb 8, 2022
Feb 8, 2022
Pender Medical ClinicPender, NE, CCN 288526 Rural health clinic W-2 Managing Employee
Operational/Managerial Control		 Feb 13, 2024
Feb 13, 2024

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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.

Hospital & facility affiliations 10

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588636800000",
    "number": "1952345167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100",
            "city": "PENDER",
            "state": "NE",
            "postal_code": "680470100",
            "telephone_number": "402-385-4004",
            "fax_number": "402-385-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "958 WELLNESS WAY STE 1",
            "city": "PENDER",
            "state": "NE",
            "postal_code": "680474518",
            "telephone_number": "402-385-3033",
            "fax_number": "402-385-3092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIMM",
        "first_name": "MATTHEW",
        "middle_name": "J.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2020-05-05",
        "certification_date": "2020-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "22930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4450726",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NE",
            "identifier": "15966",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42128384911",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pender, NE

Sources for this page

Verify at the official NPI Registry.