Basic Information
| Provider Information | |||||||||
| NPI: | 1649324690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHAEFER | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1025 MARSH ST | ||||||||
| Address2: | |||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560028673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076254031 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1025 MARSH ST | ||||||||
| Address2: | |||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560028673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076254031 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 09/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 49229 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 300004171 | 01 | MN | MEDICARE | OTHER | 6G898SC | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 16-04888 | 01 | MN | MEDICA | OTHER | HP78222 | 01 | MN | HEALTH PARTNERS | OTHER | 1649324690 | 01 | MN | AMERICA'S PPO | OTHER | 960371050961 | 01 | MN | PREFERRED ONE | OTHER | 300004172 | 01 | MN | MEDICARE | OTHER | 258140100 | 05 | MN | MEDICAID | P00437110 | 01 | MN | MEDICARE - RAILROAD | OTHER | 134332 | 01 | MN | UCARE | OTHER | 34787800 | 05 | WI | MEDICAID |