MATTHEW A KETELAAR MD
NPI 1336109180
Radiology - Diagnostic Radiology in Davenport, IA
About Matthew A Ketelaar Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MATTHEW A KETELAAR MD (NPI 1336109180) is an individual diagnostic radiology provider in Davenport, Iowa, licensed in Iowa (28007) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 6
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Matthew A Ketelaar Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Matthew Ketelaar reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Davenport, IA 52807
- Reassigned Medicare billing, Illinois enrollment
- 24 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 52807 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Matthew Ketelaar's NPI number?
The NPI number for Matthew Ketelaar is 1336109180. It was assigned to this individual provider in the NPPES registry on March 24, 2006.
Where is Matthew Ketelaar located?
Matthew Ketelaar practices at 1970 E 53rd St, Davenport, IA 52807. The listed phone number is (563) 359-3949.
What is Matthew Ketelaar's specialty?
The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.
Is Matthew Ketelaar enrolled in Medicare?
Yes. Matthew Ketelaar is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Matthew Ketelaar's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Matthew Ketelaar reassigns Medicare benefits to Radiology Group PC Sc (Davenport, IA). The 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 Matthew Ketelaar's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Matthew Ketelaar was last updated on May 5, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Matthew A Ketelaar, MD · NPI 1336109180
Diagnostic Radiology physician in Davenport, Iowa. Individual provider, active in the CMS NPPES registry since March 24, 2006.
## Identity
- **NPI:** 1336109180 (Entity type: Individual)
- **Enumerated:** March 24, 2006
- **Primary specialty:** Radiology - Diagnostic Radiology · taxonomy 2085R0202X
- **State license:** 28007 (Iowa)
- **Sole proprietor:** No
## Practice location
- **Address:** 1970 E 53RD ST, Davenport, IA 52807-2710
- **Phone:** (563) 359-3949
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Radiology Group PC Sc (NPI 1073573994, Davenport, IA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 5, 2021
- **Other identifiers:** Other 06050; Medicaid 5096792 (IA); Other 300034141; and 3 more
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Source: [NPI Profile](https://npiprofile.com/npi/1336109180) · Data from the CMS NPPES public registry.