NPIMap

Individual provider Active NPI

Matthew A Dorman, DO

  • Internal Medicine Physician
  • Estero, FL
National Provider Identifier
1013447549
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS16650 Issued in FL
Practice address
23450 Via Coconut PT
Estero, FL 34135-1877
Phone
(239) 468-0150
Fax
(239) 343-4056
NPI assigned
Jun 18, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X UO5414 FL
Internal Medicine Physician 207R00000X OS16650 FL Primary

Addresses

Primary practice location

23450 Via Coconut PT
Estero, FL 34135-1877

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 468-0150

Other practice location 1

350 7th St N
Naples, FL 34102-5754
Phone (239) 624-0030

Other identifiers 1

IdentifierTypeStateIssuer
106275700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200710000666 FL Practitioner - Internal Medicine 7315219227 Reassigns benefits to 1 organization
I20240808004745 NC Practitioner - Internal Medicine 7315219227 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Nova Southeastern College of Osteo Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

201 Dale Earnhardt Blvd
Suite 200
Kannapolis, NC 28081-0303
Phone (704) 932-1155

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
UO5414FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Charlotte-Mecklenburg Hospital Authority Internal Medicine Current Accepting new patients
Lee Memorial Health System CurrentSince Aug 30, 2020 Accepting new patients
Lee Memorial Health System CurrentSince Aug 30, 2020 Accepting new patients
Lee Memorial Health System Internal Medicine Current Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Internal Medicine CurrentSince Aug 5, 2024 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Aug 5, 2024 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Internal Medicine Past Accepting new patients

Locations

23450 Via Coconut Pt
Estero, FL 34135
Phone (239) 468-0150

8931 Colonial Center Dr
Ste 401
Fort Myers, FL 33905
Phone (239) 424-2030

2776 Cleveland Ave
Fort Myers, FL 33901
Phone (239) 343-2000

1569 Matthew Dr
Fort Myers, FL 33907
Phone (941) 939-1700

200 Medical Park Dr
Ste 250
Concord, NC 28025
Phone (704) 403-2740

1085 NE Gateway Ct NE
#200A
Concord, NC 28025
Phone (704) 403-8650

201 Dale Earnhardt Blvd
Ste 200
Kannapolis, NC 28081
Phone (704) 403-7300

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network
  • devoted network organization-92131eb0-09f2-4173-a140-cf7b381f0cf1

Interoperability endpoints

  • Direct secure messaging: mdorman2900419@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1013447549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "239-468-0150",
            "fax_number": "239-343-4056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23450 VIA COCONUT PT",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "341351877",
            "telephone_number": "239-468-0150",
            "fax_number": "239-343-4056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 7th St N",
            "address_purpose": "LOCATION",
            "city": "Naples",
            "state": "FL",
            "postal_code": "341025754",
            "country_code": "US",
            "telephone_number": "239-624-0030",
            "fax_number": "239-624-0031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DORMAN",
        "first_name": "MATTHEW",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-18",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "UO5414",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS16650",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106275700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Estero, FL

Sources for this page

Verify at the official NPI Registry.