Individual provider Active NPI

Matthew Herbert Bruntel, D.O.

  • Internal Medicine Physician
  • Rockville, MD
National Provider Identifier
1114102134
Registry record updated Dec 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS014243 Issued in PA
Practice address
15245 Shady Grove Rd Ste 130
Rockville, MD 20850
Phone
(301) 527-1650
NPI assigned
Jan 9, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS014243 PA Primary

Addresses

Primary practice location

15245 Shady Grove Rd Ste 130
Rockville, MD 20850

Mailing address

11100 Powder Horn Dr
Potomac, MD 20854-2539
Phone (202) 604-1405

Other identifiers 1

IdentifierTypeStateIssuer
020449800MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20081114000517 MD Practitioner - Internal Medicine 9436231842 Reassigns benefits to 2 organizations
I20141029000109 DC Practitioner - Internal Medicine 9436231842 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Doctors First, LLCGroup PAC ID 3870661978, 58 clinicians

Practice addresses (Care Compare)

806 W Diamond Ave
Suite 110
Gaithersburg, MD 20878-1478
Phone (301) 515-2901

Hospital & facility affiliations

  • Adventist Home Health Services, Inc. Home health agency, Silver Spring, MD, CCN 217032

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Doctors First, LLC Internal Medicine CurrentSince Jul 6, 2024 Accepting new patients
Doctors First, LLC Internal Medicine CurrentSince Jul 6, 2024 Accepting new patients
Potomac Eldercare Physicians Internal Medicine CurrentSince Jan 1, 1990 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

806 W Diamond Ave
Ste 110
Gaithersburg, MD 20878
Phone (240) 342-2407

Interoperability endpoints

  • Direct secure messaging: matthew.bruntel.1@4332.direct.athenahealth.com

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 1

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": "1199836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577318400000",
    "number": "1114102134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11100 POWDER HORN DR",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208542539",
            "telephone_number": "202-604-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15245 SHADY GROVE RD STE 130",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "20850",
            "telephone_number": "301-527-1650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNTEL",
        "first_name": "MATTHEW",
        "middle_name": "HERBERT",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-01-09",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS014243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020449800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

Verify at the official NPI Registry.