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MATCLINIC PHYSICIANS PRACTICE GROUP LLC
NPI 1174175632
Counselor - Addiction (Substance Use Disorder) in Annapolis, MD

Active since July 15, 2019CLIA 21D2165389 · Waiver
107 RIDGELY AVE STE 12, ANNAPOLIS, MD 21401(410) 220-0780(410) 862-0150 Get Directions Write a Review

NPPES record last updated: May 11, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 11, 2022, Aug 7, 2020, Apr 14, 2020 and 1 more (4 updates tracked since 2019).

About Matclinic Physicians Practice Group Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MATCLINIC PHYSICIANS PRACTICE GROUP LLC (NPI 1174175632) is a healthcare organization registered as an addiction (substance use disorder) in Annapolis, Maryland and active in the NPI registry since July 2019. The organization holds a CLIA Waiver certificate valid through April 25, 2027 and lists Dan Reck, Manager, as its authorized official.

NPPES Registry Identity

NPI1174175632
Entity TypeOrganization
Primary Taxonomy101YA0400X
Legal Business NameMATCLINIC PHYSICIANS PRACTICE GROUP LLC
Location Address107 RIDGELY AVE STE 12Annapolis, MD 21401-1417
Mailing AddressPo Box 9068Baltimore, MD 21222-0768 · (410) 220-0720 · Fax (410) 862-0150
Phone(410) 220-0780
Fax(410) 862-0150
Organization SubpartNo
Authorized OfficialDan ReckManager · (410) 220-0780
Enumeration DateJuly 15, 2019
Last NPPES UpdateMay 11, 20224 updates tracked since enumeration
NPPES CertifiedMay 11, 2022
✔ NPI 1174175632 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
Also ListedCounselor · ProfessionalTaxonomy 101YP2500X
107 RIDGELY AVE STE 12, Annapolis, MD 21401
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Other Identifiers 1

Medicaid561008702MD

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 21D2165389

Matclinic Physicians Practice Group, LLC · Annapolis, MD
Active · expires Apr 25, 2027
CLIA Number21D2165389
Laboratory TypePhysician Office
Certificate Effective DateApril 26, 2025
Certificate Expiration DateApril 25, 2027
Laboratory DirectorEnrique I. Oviedo
Laboratory Phone(410) 302-1296
Laboratory LocationMatclinic Physicians Practice Group, LLC107 Ridgely Avenue Suite 12, Annapolis, MD 21401
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MATCLINIC PHYSICIANS PRACTICE GROUP LLC
Clinic/Center (Mental Health (Including Community Mental Health Center))
107 RIDGELY AVE STE 12
ANNAPOLIS, MD 21401
Anne Arundel County (410) 220-0780
MATCLINIC PHYSICIANS PRACTICE GROUP LLC
Internal Medicine (Addiction Medicine)
107 RIDGELY AVE STE 12
ANNAPOLIS, MD 21401
Anne Arundel County (410) 220-0780
MATCLINIC PHYSICIANS PRACTICE GROUP LLC
Clinic/Center (Rehabilitation, Substance Use Disorder)
107 RIDGELY AVE STE 12
ANNAPOLIS, MD 21401
Anne Arundel County (410) 220-0780
MATCLINIC PHYSICIANS PRACTICE GROUP LLC
Community/Behavioral Health
107 RIDGELY AVE STE 12
ANNAPOLIS, MD 21401
Anne Arundel County (410) 220-0780

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Matclinic Physicians Practice Group LLC's NPI number?

The NPI number for Matclinic Physicians Practice Group LLC is 1174175632. It was assigned to this organization in the NPPES registry on July 15, 2019.

Where is Matclinic Physicians Practice Group LLC located?

Matclinic Physicians Practice Group LLC is located at 107 Ridgely Ave Ste 12, Annapolis, MD 21401. The listed phone number is (410) 220-0780.

What is Matclinic Physicians Practice Group LLC's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Does Matclinic Physicians Practice Group LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 21D2165389) is associated with this NPI, valid through April 25, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Matclinic Physicians Practice Group LLC was last updated on May 11, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.