Individual provider Active NPI

Matthew Kyle McHugh

  • General Practice Dentistry
  • Commerce City, CO
National Provider Identifier
1972167013
Registry record updated Dec 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
00204241 Issued in CO
Practice address
15151 E 104TH Ave Ste 103
Commerce City, CO 80022-8948
Phone
(303) 287-7000
NPI assigned
Apr 24, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
General Practice Dentistry 1223G0001X 00204241 CO Primary

Addresses

Primary practice location

15151 E 104TH Ave Ste 103
Commerce City, CO 80022-8948

Mailing address

3701 W Akeman Bridge Rd
Columbia, MO 65202-7241
Phone (573) 999-1083

Other practice location 1

5640 South St Ste 1
Lincoln, NE 68506-2231
Phone (402) 489-0787

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
00204241COMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Reunion Smiles Dentistry and Orthodontics, LLP General Practice CurrentSince Feb 13, 2022 Accepting new patients
Dental Professionals of Nebraska, PC General Practice PastSince Dec 3, 2023 Accepting new patients
Susan M Christensen DDS PC General Practice Past Accepting new patients

Locations

15151 E 104th Ave
Ste 103
Commerce City, CO 80022
Phone (303) 287-7000

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1556064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576886400000",
    "number": "1972167013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 W AKEMAN BRIDGE RD",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652027241",
            "telephone_number": "573-999-1083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15151 E 104TH AVE STE 103",
            "city": "COMMERCE CITY",
            "state": "CO",
            "postal_code": "800228948",
            "telephone_number": "303-287-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5640 South St Ste 1",
            "address_purpose": "LOCATION",
            "city": "Lincoln",
            "state": "NE",
            "postal_code": "685062231",
            "country_code": "US",
            "telephone_number": "402-489-0787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCHUGH",
        "first_name": "MATTHEW",
        "middle_name": "KYLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-24",
        "last_updated": "2019-12-21",
        "certification_date": "2019-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "00204241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Commerce City, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.