MATTHEW R JACKSON D.O.
NPI 1588897896
Family Medicine - Sports Medicine in Traverse City, MI
NPI Status: Active since September 02, 2009
Contact Information
1225 W FRONT ST
TRAVERSE CITY, MI
ZIP 49684
Phone: (231) 935-0788
Fax: (231) 935-0787
- Individual
- Male
- Years of Experience 21
- Family Medicine
- Sports Medicine
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
About MATTHEW JACKSON
This page provides the complete NPI Profile along with additional information for Matthew Jackson, a primary care provider established in Traverse City, Michigan with a medical specialization in Family Medicine, focusing in sports medicine and more than 21 years of experience. The healthcare provider is registered in the NPI registry with number 1588897896 assigned on September 2009. The practitioner's primary taxonomy code is 207QS0010X with license number 5101018472 (MI). The provider is registered as an individual and his NPI record was last updated 5 years ago.
- NPI
- 1588897896
- Provider Name
- MATTHEW R JACKSON D.O.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 1225 W FRONT ST TRAVERSE CITY, MI 49684
- Location Phone
- (231) 935-0788
- Location Fax
- (231) 935-0787
- Mailing Address
- 1225 W FRONT ST TRAVERSE CITY, MI 49684
- Mailing Phone
- (231) 935-0788
- Mailing Fax
- (231) 935-0787
- Medical School Name
- OTHER
- Graduation Year
- 2005
- Is Sole Proprietor?
- No
- Enumeration Date
- 09-02-2009
- Last Update Date
- 12-21-2020
- Code Navigator
A primary care provider (PCP) like Matthew Jackson sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Family Medicine Sports Medicine
- Taxonomy Code
- 207QS0010X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 5101018472
- License State
- MI
- Taxonomy Description
- A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
---|---|---|---|---|
1 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | 5101018472 (MI) |
2 | 207QS0010X | Allopathic & Osteopathic Physicians | Family Medicine | 34.010954 (OH) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Cross� Preferred HMO Bronze Extra - HMO
- Blue Cross� Preferred HMO Bronze Saver HSA - HMO
- Blue Cross� Preferred HMO Bronze Secure - HMO
- Blue Cross� Preferred HMO Gold - HMO
- Blue Cross� Preferred HMO Gold Extra - HMO
- Blue Cross� Preferred HMO Silver - HMO
- Blue Cross� Preferred HMO Silver Extra - HMO
- Blue Cross� Preferred HMO Silver Saver - HMO
- Blue Cross� Preferred HMO Value - HMO
- Blue Cross� Select HMO Bronze Extra - HMO
- Blue Cross� Premier PPO Bronze Extra - PPO
- Blue Cross� Premier PPO Bronze HSA - PPO
- Blue Cross� Premier PPO Bronze Secure - PPO
- Blue Cross� Premier PPO Gold - PPO
- Blue Cross� Premier PPO Gold Extra - PPO
- Blue Cross� Premier PPO Silver - PPO
- Blue Cross� Premier PPO Silver Extra - PPO
- Blue Cross� Premier PPO Silver Saver HSA - PPO
- Blue Cross� Premier PPO Value - PPO
- Bronze First - HMO
- Bronze First Adult Vision & Fitness - HMO
- Diabetes Gold - HMO
- Diabetes Gold Adult Vision & Fitness - HMO
- Diabetes Silver - HMO
- Diabetes Silver Adult Vision & Fitness - HMO
- Gold - HMO
- Gold Adult Vision & Fitness - HMO
- HDHP Preventive Silver - HMO
- Healthy Heart Gold - HMO
- MHP Bronze - HMO
- MHP Bronze Saver (Expanded) - HMO
- MHP Expanded Bronze Standard - HMO
- MHP Gold - HMO
- MHP Gold Standard - HMO
- MHP Silver Exchange - HMO
- MHP Silver Exchange Rewards - HMO
- MHP Silver Standard - HMO
- MHP Young Adult/Catastrophic - HMO
- Bronze 4 - HMO
- Bronze 8 - HMO
- Gold 1 - HMO
- Gold 1 with Adult Vision Services - HMO
- Gold 12 - HMO
- Gold 8 - HMO
- Gold 8 with Rx Copay - HMO
- Silver 1 - HMO
- Silver 1 with Adult Vision Services - HMO
- Silver 1 with Rx Copay and Adult Vision Services - HMO
- MyPriority Balanced Silver - HMO
- MyPriority Premier Silver - HMO
- MyPriority Standard Bronze - HMO
- MyPriority Standard Bronze - Travel - HMO
- MyPriority Standard Gold - HMO
- MyPriority Standard Silver - HMO
- MyPriority Standard Silver - Travel - HMO
- MyPriority Value Bronze - HMO
- MyPriority Value Bronze HSA - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
Matthew Jackson is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
Matthew Jackson is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
PECOS PAC ID: 5597994087
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20140818002073
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Provider Referred Orders for Durable Medical Equipment, Devices & Supplies
The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.
Durable Medical Equipment
DME-Oxygen and Supplies (DC002N)
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)
1 DME suppliers used 12 Medicare Claims 12 Services Paid
DME-Other DME (DE017N)
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service (HCPCS:K0553)
1 DME suppliers used 12 Medicare Claims 12 Services Paid
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Administration of influenza virus vaccine
Administration of pneumococcal vaccine
Annual depression screening, 15 minutes
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
Aspiration and/or injection of fluid from large joint
Aspiration and/or injection of fluid large joint using ultrasound guidance
Automated urinalysis test
Established patient office or other outpatient visit, 10-19 minutes
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Established patient office or other outpatient visit, 40-54 minutes
Hemoglobin a1c level
Influenza vaccine split virus, preservative free
Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage
Injection of drug or substance under skin or into muscle
Injection, methylprednisolone acetate, 40 mg
Injection, methylprednisolone acetate, 80 mg
New patient office or other outpatient visit, 30-44 minutes
New patient office or other outpatient visit, 45-59 minutes
Smoking and tobacco use intensive counseling, 4-10 minutes
Transitional care management services for problem of high complexity
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
This service was performed 53 times for 53 patientsThe pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.
This service was performed 16 times for 16 patientsAn annual depression screening is a short, routine evaluation to check for signs of depression. It involves answering a series of questions about your feelings, thoughts, and behaviors. The process takes about 15 minutes and helps detect depression early for better management.
This service was performed 61 times for 61 patientsAn annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
This service was performed 135 times for 135 patientsThis procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.
This service was performed 17 times for 12 patientsThis procedure involves using ultrasound technology to accurately locate a large joint, usually the knee or shoulder. A needle is then inserted to either extract fluid (aspiration) or inject medication. The ultrasound helps ensure precision and safety.
This service was performed 59 times for 32 patientsAn automated urinalysis test is a routine examination that checks your urine for various substances. It can help identify potential health issues such as kidney problems or diabetes. The test uses a machine to analyze a small urine sample, providing quick and accurate results.
This service was performed 30 times for 25 patientsThis is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.
This service was performed 14 times for 13 patientsThis is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
This service was performed 270 times for 182 patientsThis is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
This service was performed 433 times for 265 patientsThis service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
This service was performed 86 times for 75 patientsHemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.
This service was performed 45 times for 37 patientsThe Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
This service was performed 37 times for 37 patientsThe quadrivalent influenza vaccine is a shot to protect you from four different flu viruses. It's preservative-free and given in a 0.5 ml dose. It helps your body build immunity to the flu, reducing your risk of getting sick.
This service was performed 15 times for 15 patientsThis procedure involves administering medication directly under the skin or into a muscle. A small needle is used to inject the drug, allowing it to be absorbed quickly into the bloodstream. It's a common method for delivering a variety of medications.
This service was performed 22 times for 18 patientsMethylprednisolone acetate is a medication given through an injection. It's a type of corticosteroid, which reduces inflammation and immune responses. It can be used to treat various conditions like arthritis, allergies, and skin diseases. This dose is 40 mg.
This service was performed 32 times for 22 patientsMethylprednisolone acetate is a strong anti-inflammatory medication. It is often given as an 80 mg injection to reduce inflammation and pain. It's commonly used for conditions like arthritis, allergic disorders, or other inflammatory diseases.
This service was performed 21 times for 19 patientsThis service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
This service was performed 12 times for 12 patientsThis is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
This service was performed 23 times for 23 patientsThis service provides brief, intensive counseling (4-10 minutes) to support you in quitting smoking or tobacco use. It involves discussing the risks of tobacco use, benefits of quitting, and strategies to help you stop. It's a critical step towards a healthier lifestyle.
This service was performed 13 times for 11 patientsTransitional care management services are designed to ensure a smooth transition from a hospital to home or another care setting for patients with complex health issues. These services include medication management, patient education, and coordination with healthcare providers.
This service was performed 31 times for 26 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $21.18 for a new patient copayment and $24.11 for an established patient copayment.
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 49684 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $84.74
- Minimum New Patient Price $54.34
- Maximum New Patient Price $166.68
- Average New Patient Copayment $21.18
- Minimum New Patient Copayment $13.58
- Maximum New Patient Copayment $41.67
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $96.44
- Minimum Established Patient Price $17.09
- Maximum Established Patient Price $135.4
- Average Established Patient Copayment $24.11
- Minimum Established Patient Copayment $4.27
- Maximum Established Patient Copayment $33.85
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Find Provider Hospital Affiliations - Privileges
Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.
Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Matthew Jackson is affiliated with the following medical facilities:
Hospital Name | Address | Phone | Hospital Type | Overall Rating |
---|---|---|---|---|
MUNSON MEDICAL CENTER | 1105 SIXTH STREET TRAVERSE CITY, MI 49684 | (231) 935-5000 | Acute Care Hospitals | |
PAUL OLIVER MEMORIAL HOSPITAL | 224 PARK AVENUE FRANKFORT, MI 49635 | (231) 352-2200 | Critical Access Hospitals |
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
1 | 5 | 8 | 8 | 8 | 9 | 7 | 8 | 9 | 6 |
Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
2 | 5 | 16 | 8 | 16 | 9 | 14 | 8 | 18 | |
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
2 + 5 + 1 + 6 + 8 + 1 + 6 + 9 + 1 + 4 + 8 + 1 + 8 + 24 = 84 | |||||||||
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
90 - 84 = 6 | 6 |
The NPI number 1588897896 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 13 providers are registered at the same or nearby location.
NPI | Name / Type | Taxonomy | Address |
---|---|---|---|
1790875649 | DOUGLAS M SPENCE JR. MD Individual | Family Medicine | 1225 W FRONT ST TRAVERSE CITY, MI 49684 (231) 935-0788 |
1275743767 | SARAH MAE BANCROFT-TREADWAY M.D. Individual | Family Medicine (Sports Medicine) | 1225 W FRONT ST TRAVERSE CITY, MI 49684 (231) 935-0788 |
1336117456 | NANCY MORRIS PAC Individual | Physician Assistant | 1225 W FRONT ST TRAVERSE CITY, MI 49684 (231) 935-0788 |
1407906241 | DAVID JAY LYONS MPT Individual | Physical Therapist | 1225 W FRONT ST TRAVERSE CITY, MI 49684 (231) 935-0788 |
1558390799 | CREEKSIDE CLINIC, LLC Organization | Family Medicine | 1225 W FRONT ST TRAVERSE CITY, MI 49684 (231) 935-0788 |
1104051184 | JENNIFER NICOLE DRAKE PT Individual | Physical Therapist | 1225 W FRONT ST TRAVERSE CITY, MI 49684 (231) 935-0788 |
1801979679 | MRS. PATRICIA RENEE TKACH P.T. Individual | Physical Therapist | 1225 W FRONT ST TRAVERSE CITY, MI 49684 (231) 935-0788 |
1265459267 | STACY N SLADE PA Individual | Physician Assistant | 1225 W FRONT ST TRAVERSE CITY, MI 49684 (231) 935-0788 |
1932598976 | RANGER VASCULAR AND VEIN CENTER PLLC Organization | Clinic/Center (Health Service) | 1225 W FRONT ST SUITE B TRAVERSE CITY, MI 49684 (231) 360-1775 |
1679957617 | CRYSTAL LAKE CLINIC P.C. Organization | Family Medicine | 1225 W FRONT ST SUITE C TRAVERSE CITY, MI 49684 (231) 715-3601 |
1891717039 | MEREDITH L MCDONALD PA-C Individual | Physician Assistant | 1225 W FRONT ST TRAVERSE CITY, MI 49684 (231) 935-0788 |
1558647354 | MARIA I CUPP PA-C Individual | Physician Assistant | 1225 W FRONT ST TRAVERSE CITY, MI 49684 (231) 935-0788 |
1710745302 | ANTHONY J BOUWHUIS CPO Individual | Prosthetist | 1225 W FRONT ST TRAVERSE CITY, MI 49684 (231) 947-5701 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1588897896, enumerated in the NPI registry as an "individual" on September 02, 2009
The provider is located at 1225 W Front St Traverse City, Mi 49684 and the phone number is (231) 935-0788
The provider's speciality is Family Medicine with taxonomy code 207QS0010X with a focus in Sports Medicine
The provider has more than 21 years of experience.
The provider might be accepting Accepts: Blue Care Network of Michigan, Blue Cross Blue. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
Medicare beneficiaries should expect a typical cost of $84.74 with an average copayment of $21.18 for new patient appointments. Established patients should expect a typical charge of $96.44 and an average copayment of 24.11. Please review your insurance plan or contact the provider directly to determine your specific costs.
The most common procedures or services performed by this practitioner are: Administration of influenza virus vaccine, Administration of pneumococcal vaccine, Annual depression screening, 15 minutes, Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit, Aspiration and/or injection of fluid from large joint, Aspiration and/or injection of fluid large joint using ultrasound guidance, Automated urinalysis test, Established patient office or other outpatient visit, 10-19 minutes, Established patient office or other outpatient visit, 20-29 minutes, Established patient office or other outpatient visit, 30-39 minutes, Established patient office or other outpatient visit, 40-54 minutes, Hemoglobin a1c level, Influenza vaccine split virus, preservative free, Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage, Injection of drug or substance under skin or into muscle, Injection, methylprednisolone acetate, 40 mg, Injection, methylprednisolone acetate, 80 mg, New patient office or other outpatient visit, 30-44 minutes, New patient office or other outpatient visit, 45-59 minutes, Smoking and tobacco use intensive counseling, 4-10 minutes and Transitional care management services for problem of high complexity.
The practitioner is affiliated to the following hospital(s): MUNSON MEDICAL CENTER and PAUL OLIVER MEMORIAL HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
This NPI record was last updated on September 02, 2009. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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