Individual provider Active NPI

Sajida Mathew, MD

  • Psychiatry Physician
  • Rockledge, FL
National Provider Identifier
1164510509
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
ME119338 Issued in FL
Practice address
220 Barton Blvd Unit C-14
Rockledge, FL 32955-2742
Phone
(321) 241-6800
Fax
(321) 241-6890
NPI assigned
Oct 11, 2006
Last updated
Jun 27, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X ME119338 FL Primary

Addresses

Primary practice location

220 Barton Blvd Unit C-14
Rockledge, FL 32955-2742

Mailing address

PO Box 1137
Melbourne, FL 32902-1137
Phone (321) 952-9696

Other identifiers 2

IdentifierTypeStateIssuer
4848294MedicaidMI
ME119338OtherFLFL STATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20140822001363 FL Practitioner - Psychiatry 1850284233 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brevard Health Alliance IncGroup PAC ID 0446201768, shared by 18 NPIs, 50 clinicians

Practice addresses (Care Compare)

17 Silver Palm Ave
Melbourne, FL 32901-3123
Phone (321) 241-6800

220 Barton Blvd
Rockledge, FL 32955-2742
Phone (321) 241-6800

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME119338FLMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Parwati Maddali MD Professional Association Psychiatry CurrentSince Jul 1, 2016 Accepting new patients
Personal Recovery Network LLC Psychiatry CurrentSince Jan 4, 2021 Accepting new patients
List Psychological Services, PLC Psychiatry Past Accepting new patients
Tuscola County Community Mental Health Services Board PastSince Oct 6, 2008 Accepting new patients
New Center Community Mental Health Services PastSince Sep 2, 2008 Accepting new patients
New Center Community Mental Health Services Past Accepting new patients

Locations

260 Lookout Pl
Ste 202
Maitland, FL 32751
Phone (407) 537-9450

6718 Lake Nona Blvd
Orlando, FL 32827
Phone (407) 476-1222

845 Executive Ln
Ste 100
Rockledge, FL 32955
Phone (321) 631-4222

Interoperability endpoints

  • Direct secure messaging: sajida.mathew@bha.eclinicaldirectplus.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1164510509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1137",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329021137",
            "telephone_number": "321-952-9696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 BARTON BLVD UNIT C-14",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329552742",
            "telephone_number": "321-241-6800",
            "fax_number": "321-241-6890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "SAJIDA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME119338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4848294",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL STATE LICENSE",
            "identifier": "ME119338",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockledge, FL

Sources for this page

Verify at the official NPI Registry.