NPIMap

Individual provider Active NPI

Matthew Leonard Gomberg, PA

  • Physician Assistant
  • Falmouth, MA
National Provider Identifier
1093281446
Registry record updated Apr 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
100 Ter Heun Drive
Falmouth, MA 02540
Phone
(413) 539-8800
NPI assigned
Oct 23, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

100 Ter Heun Drive
Falmouth, MA 02540

Mailing address

114 W Pelham Rd
Shutesbury, MA 01072-9784
Phone (413) 539-8800

Other practice location 1

650 Huebner Rd
Fort Riley, KS 66442-4030
Phone (413) 539-8800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20190228002229 MA Practitioner - Physician Assistant 8921347378 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Urgi Center Medical GroupGroup PAC ID 3476790601, 83 clinicians

Practice addresses (Care Compare)

273 Teaticket Hwy
Teaticket, MA 02536-5638
Phone (508) 495-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
025877NYMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center of Cape Cod, Inc. CurrentSince Jun 15, 2023 Accepting new patients
Community Health Center of Cape Cod Inc CurrentSince Jun 15, 2023 Accepting new patients

Locations

107 Commercial St
Mashpee, MA 02649
Phone (508) 539-6000

Interoperability endpoints

  • Direct secure messaging: mgomberg642120@direct.ochin.org

Organizations & group practices 6

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 9

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": "1540252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554163200000",
    "number": "1093281446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 W PELHAM RD",
            "city": "SHUTESBURY",
            "state": "MA",
            "postal_code": "010729784",
            "telephone_number": "413-539-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 TER HEUN DRIVE",
            "city": "FALMOUTH",
            "state": "MA",
            "postal_code": "02540",
            "telephone_number": "413-539-8800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "650 Huebner Rd",
            "address_purpose": "LOCATION",
            "city": "Fort Riley",
            "state": "KS",
            "postal_code": "664424030",
            "country_code": "US",
            "telephone_number": "413-539-8800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOMBERG",
        "first_name": "MATTHEW",
        "middle_name": "LEONARD",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-23",
        "last_updated": "2019-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Falmouth, MA

Sources for this page

Verify at the official NPI Registry.