NPIMap

Individual provider Active NPI

Robert Enrico Dematteo, MD

  • Internal Medicine Physician
  • Yonkers, NY
National Provider Identifier
1083610125
Registry record updated Sep 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
173247 Issued in NY
Practice address
970 North Broadway
Suite 209
Yonkers, NY 10701-1311
Phone
(914) 965-3366
Fax
(914) 965-1310
NPI assigned
Jun 23, 2005
Last updated
Sep 13, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 173247 NY
Internal Medicine Physician 207R00000X 173247 NY Primary

Addresses

Primary practice location

970 North Broadway
Suite 209
Yonkers, NY 10701-1311

Mailing address

970 North Broadway
Suite 209
Yonkers, NY 10701-1311
Phone (914) 965-3366

Other identifiers 1

IdentifierTypeStateIssuer
01066435MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031103000557 NY Practitioner - Internal MedicinePractitioner - Pulmonary Disease 5092627554 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pulmonary Disease
Education
Other, 1982
Medicare assignment
May accept Medicare assignment
Group practices
Pulmonary Disease Group of Westchester PLLCGroup PAC ID 8123213832, 4 clinicians

Practice addresses (Care Compare)

970 N Broadway
Suite 209
Yonkers, NY 10701-1311
Phone (914) 965-3366

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.08 of 100Reported as individual
Quality
100
Improvement activities
40
Cost
60.26

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
173247NYMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
L&a Operations LLC Past Accepting new patients

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: rdematteo@stjohnsmedicalpc.directmedgenehr.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St. John's Riverside HospitalYonkers, NY, CCN 330208 Hospital Corporate Director (2%) Mar 29, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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

Hospital & facility affiliations 3

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": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536796800000",
    "number": "1083610125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 NORTH BROADWAY",
            "address_2": "SUITE 209",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107011311",
            "telephone_number": "914-965-3366",
            "fax_number": "914-965-1310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 NORTH BROADWAY",
            "address_2": "SUITE 209",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107011311",
            "telephone_number": "914-965-3366",
            "fax_number": "914-965-1310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMATTEO",
        "first_name": "ROBERT",
        "middle_name": "ENRICO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2018-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "173247",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "173247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01066435",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yonkers, NY

Sources for this page

Verify at the official NPI Registry.