Active NPI
Dara Matseoane-Peterssen, M.D.
- Obstetrics & Gynecology Physician
- New York, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 221332-1
- Practice address
- 5141 Broadway
New York, NY 10034-1159 - Phone
- (212) 305-4098
- Fax
- (212) 305-4098
- NPI assigned
- Jul 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 221332-1 | NY | Primary |
Addresses
Primary practice location
5141 Broadway
New York, NY 10034-1159
Mailing address
622 W 168TH St
New York, NY 10032-3720
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02177824 | Medicaid | NY |
Electronic endpoints 3
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) | |
| FHIR URL | https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/ | Health Information Exchange (HIE) | |
| Direct Messaging Address | matseod@direct.nyp.org | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Obstetrics/Gynecology
- Education
- Columbia University College of Physicians and Surgeons, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Trustees of Columbia University in the City of New York
Practice addresses (Care Compare)
21 Audubon Ave
New York, NY 10032-2275
Phone (212) 342-3231
51 W 51St St
New York, NY 10019-6113
Phone (212) 326-5705
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 221332-1 | NY | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trustees of Columbia University in the City of New York | Obstetrics & Gynecology | Current | Accepting new patients |
| Trustees of Columbia University in the City of New York | Current | Accepting new patients | |
| Trustees of Columbia University in the City of New York | Obstetrics & Gynecology | Current | Accepting new patients |
| The New York and Presbyterian Hospital | Past | Accepting new patients | |
| Trustees of Columbia University Dept of Obstetrics and GYN Ultrasound | Past | Accepting new patients |
Locations
622 W 168th St
New York, NY 10032
Phone (212) 305-4931
161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559
5141 Broadway
New York, NY 10034
Phone (212) 932-4000
622 W 168th St
Ph 1624
New York, NY 10032
Phone (212) 305-4098
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
Interoperability endpoints
- https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
- https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
- matseod@direct.nyp.org
Organizations & group practices 5
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.
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- Surgery Physician
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- NPI 1508266347
Obstetrics & Gynecology
-
- Internal Medicine Physician
- Fort Lee, NJ
- NPI 1982993184
NY, Obstetrics & Gynecology
-
- Internal Medicine Physician
- New York, NY
- NPI 1699289488
-
- General Acute Care Hospital
- New York, NY
- NPI 1194832477
-
- Specialist
- New York, NY
- NPI 1366467243
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680134400000",
"number": "1174549737",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "622 W 168TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5141 BROADWAY",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100341159",
"telephone_number": "212-305-4098",
"fax_number": "212-305-4098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATSEOANE-PETERSSEN",
"first_name": "DARA",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-15",
"last_updated": "2023-03-30",
"certification_date": "2023-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "NY",
"license": "221332-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02177824",
"state": "NY"
}
],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "N",
"endpointDescription": "FHIR",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "FHIR",
"address_1": "5141 Broadway",
"city": "New York",
"state": "NY",
"country_code": "US",
"postal_code": "100341159",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/",
"affiliation": "N",
"endpointDescription": "FHIR",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "FHIR",
"address_1": "5141 Broadway",
"city": "New York",
"state": "NY",
"country_code": "US",
"postal_code": "100341159",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "matseod@direct.nyp.org",
"affiliation": "N",
"endpointDescription": "Direct Address",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Direct address",
"address_1": "5141 Broadway",
"city": "New York",
"state": "NY",
"country_code": "US",
"postal_code": "100341159",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; 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.