Matthew Clark Nicholson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046008729 Issued in IL

Practice address

352 Brown Blvd
Bourbonnais, IL 60914-2458

Phone

(815) 932-2020

Fax

(815) 937-0060

NPI assigned

Aug 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fisher-Swale-Nicholson Eye Center SCGroup PAC ID 3173585858, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Riverside Medical Center Hospital, Kankakee, IL, CCN 140186

Merit-based Incentive Payment System (MIPS)

Final score

82.31 of 100Reported as group

Quality

100

Improvement activities

40

Cost

41.05

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Fisher-Swale-Nicholson Eye Center SC

  • Ophthalmology Physician
  • Bourbonnais, IL
  • NPI 1639277940

  Optometrist

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Riverside Medical Center

  • General Acute Care Hospital
  • Kankakee, IL
  • NPI 1538208210
  Care Compare affiliation

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1992713309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "352 BROWN BLVD",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142458",
            "telephone_number": "815-932-2020",
            "fax_number": "815-937-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "352 BROWN BLVD",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142458",
            "telephone_number": "815-932-2020",
            "fax_number": "815-937-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "MATTHEW",
        "middle_name": "CLARK",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046008729",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED SUBSTANCE",
            "identifier": "346001680",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nepomuceno Family Practice LLC
• Jennifer Pablo Nepomuceno, M.D.
• Reynaldo Elazegui Nepomuceno, M.D.
• Melissa D Newell
• Nicholas Rutkowski, O.D. & Associates LLC
• Casey L Nicole, MS, ATC
• Nims Chiropractic LTD.
• Scott L. Nims, D.C.
• Molly Nordmeyer
• Janet Mary Notton

• Optometrist in Bourbonnais, IL
• Providers in Bourbonnais, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.