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MATCLINIC PHYSICIANS PRACTICE GROUP LLC
NPI 1194217091
Internal Medicine - Addiction Medicine in Laurel, MD

Active since June 06, 2018CLIA 21D2143493 · Waiver
601 7TH ST STE 304, LAUREL, MD 20707(410) 220-0280(410) 862-0150 Get Directions Write a Review

NPPES record last updated: May 11, 2022. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: May 11, 2022, Jan 14, 2021, Aug 7, 2020 and 2 more (5 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 1194217091) is a healthcare organization registered as an addiction medicine in Laurel, Maryland and active in the NPI registry since June 2018. The organization holds a CLIA Waiver certificate valid through January 30, 2028 and lists Dan Reck, Manager, as its authorized official.

NPPES Registry Identity

NPI1194217091
Entity TypeOrganization
Primary Taxonomy207RA0401X
Legal Business NameMATCLINIC PHYSICIANS PRACTICE GROUP LLC
Location Address601 7TH ST STE 304Laurel, MD 20707-4011
Mailing AddressPo Box 9068Baltimore, MD 21222-0768 · (410) 220-0720 · Fax (410) 862-0150
Phone(410) 220-0280
Fax(410) 862-0150
Organization SubpartNo
Authorized OfficialDan ReckManager · (410) 220-0780
Enumeration DateJune 6, 2018
Last NPPES UpdateMay 11, 20225 updates tracked since enumeration
NPPES CertifiedMay 11, 2022
✔ NPI 1194217091 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 7

★ Primary SpecialtyInternal Medicine · Addiction MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207RA0401X
Definition
An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
Also ListedCounselor · ProfessionalTaxonomy 101YP2500X
Also ListedPsychiatry & Neurology · Addiction MedicineTaxonomy 2084A0401X
Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X
Also ListedNurse Practitioner · Psychiatric/Mental HealthTaxonomy 363LP0808X
601 7TH ST STE 304, Laurel, MD 20707
Open in Google Maps ↗

Other Identifiers 1

Medicaid818073300MD

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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Matclinic Physicians Practice Group Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

11

Medicare enrollment records show 11 clinicians reassign Medicare billing to Matclinic Physicians Practice Group LLC, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (11)

Joshua Han, CRNP-F
Nurse Practitioner
NPI 1154514859
1600 CRAIN HWY S SUITE 310
Glen Burnie, MD 21061
(410) 787-8315
✔ PECOS12 mi
Vanessa Thomas, CRNP
Nurse Practitioner
NPI 1639179104
8028 RITCHIE HWY STE 210
Pasadena, MD 21122
(410) 766-1995
✔ PECOS14 mi
Stacy Edwards, CRNP
Nurse Practitioner
NPI 1982424131
227 ELIZABETH AVE
Lansdowne, MD 21227
(443) 465-6941
✔ PECOS15 mi
Nicole Diodato, CRNP
Nurse Practitioner
NPI 1033786363
306 W REDWOOD ST STE 201
Baltimore, MD 21201
(443) 806-8858
✔ PECOS18 mi
Ashley Faiella
Nurse Practitioner
NPI 1316770985
2077 SOMERVILLE RD
Annapolis, MD 21401
(410) 497-8909
✔ PECOS19 mi
Adeline Asonganyi, CRNP-PMH
Nurse Practitioner
NPI 1093604381
4116 BROOKSIDE OAKS
Owings Mills, MD 21117
(443) 750-7028
✔ PECOS20 mi
Obinneamaka Iweh Popoko, FNP
Nurse Practitioner
NPI 1528547767
40 S DUNDALK AVE
Baltimore, MD 21222
(410) 220-0720
✔ PECOS21 mi
Jenene Mcdowell
Nurse Practitioner
NPI 1821552282
4630 BELAIR RD STE A
Baltimore, MD 21206
(443) 990-1710
✔ PECOS22 mi
Stecy Ola, NP
Nurse Practitioner
NPI 1609204528
10806 REISTERSTOWN RD STE 1F
Owings Mills, MD 21117
(708) 497-0734
✔ PECOS23 mi
Evelyn-Lydia Gyamfi
Nurse Practitioner
NPI 1811589443
813 UNITED CT
Aberdeen, MD 21001
(443) 417-7346
✔ PECOS46 mi
Lisa Turner, FNP
Nurse Practitioner
NPI 1134558208
1821 SWEETBAY DR STE 1
Salisbury, MD 21804
(571) 431-8713
✔ PECOS87 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 21D2143493

Matclinic Physicians Practice Group LLC · Laurel, MD
Active · expires Jan 30, 2028
CLIA Number21D2143493
Laboratory TypePhysician Office
Certificate Effective DateJanuary 31, 2026
Certificate Expiration DateJanuary 30, 2028
Laboratory DirectorEnrique I. Oviedo
Laboratory Phone(410) 302-1296
Laboratory LocationMatclinic Physicians Practice Group LLC601 7th Street Suite 304, Laurel, MD 20707
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

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 1194217091. It was assigned to this organization in the NPPES registry on June 6, 2018.

Where is Matclinic Physicians Practice Group LLC located?

Matclinic Physicians Practice Group LLC is located at 601 7th St Ste 304, Laurel, MD 20707. The listed phone number is (410) 220-0280.

What is Matclinic Physicians Practice Group LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Addiction Medicine, with taxonomy code 207RA0401X.

Is Matclinic Physicians Practice Group LLC enrolled in Medicare?

Yes. Matclinic Physicians Practice Group LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Matclinic Physicians Practice Group LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 11 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Matclinic Physicians Practice Group LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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

Yes. A Certificate of Waiver (number 21D2143493) is associated with this NPI, valid through January 30, 2028. 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.