Matthew Julian Wideroff, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

ME167382 Issued in FL

Practice address

61 Memorial Medical Pkwy Ste 3805
Palm Coast, FL 32164-5982

Phone

(386) 586-1605

Fax

(386) 586-1607

NPI assigned

May 31, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SD, FL2 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

Specialty

General Surgery

Education

University of Miami, LM Miller School of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Florida Hospital Healthcare Partners, IncGroup PAC ID 7012266836, 621 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• AdventHealth Palm Coast Hospital, Palm Coast, FL, CCN 100118
• Adventhealth Palm Coast Parkway Hospital, Palm Coast, FL, CCN 100363

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• Direct secure messaging: mwideroff3079061@adventhealth.direct-ci.com

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.

• Florida Hospital Healthcare Partners, Inc

  • Internal Medicine Physician
  • Daytona Beach, FL
  • NPI 1780100529

  Surgery

  Medicare reassignment Care Compare group NPD
• Monument Health Rapid City Hospital, Inc

  dba Monument Health Behavioral Health Center

  • Multi-Specialty Clinic/Center
  • Rapid City, SD
  • NPI 1275553463
  Medicare reassignment NPD
• Memorial Hospital Flagler Inc

  dba AdventHealth Palm Coast

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1679678486
  NPD
• Memorial Hospital Flagler Inc.

  dba AdventHealth Medical Group

  • Multi-Specialty Clinic/Center
  • Palm Coast, FL
  • NPI 1558530600
  NPD
• Monument Health Rapid City Hospital Inc

  dba Monument Health Rapid Valley Clinic

  • Urgent Care Clinic/Center
  • Rapid City, SD
  • NPI 1215727854
  NPD
• Monument Health Rapid City Hospital, Inc.

  dba Monument Health Dermatology and Plastic Surgery

  • Multi-Specialty Clinic/Center
  • Rapid City, SD
  • NPI 1871972794
  NPD
• Adventhealth Primary Care Network Inc

  • Family Medicine Physician
  • Altamonte Springs, FL
  • NPI 1093493637
  NPD (past)

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

• Adventhealth Palm Coast Parkway Inc

  dba Adventhealth Palm Coast Parkway

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1861102345
  Care Compare affiliation
• Memorial Hospital Flagler Inc

  dba AdventHealth Palm Coast

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1679678486
  Care Compare affiliation

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

{
    "created_epoch": "1275264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1134448129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 935921",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311935921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 MEMORIAL MEDICAL PKWY STE 3805",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321645982",
            "telephone_number": "386-586-1605",
            "fax_number": "386-586-1607"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2805 5th St",
            "address_purpose": "LOCATION",
            "city": "Rapid City",
            "state": "SD",
            "postal_code": "57701",
            "country_code": "US",
            "telephone_number": "605-755-5700",
            "fax_number": "605-755-5701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIDEROFF",
        "first_name": "MATTHEW",
        "middle_name": "JULIAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-31",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME167382",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SD",
            "license": "9934",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.