Individual provider Active NPI

Daniel De Fazio Mathews, D.P.M.

  • Foot Surgery Podiatrist
  • Boca Raton, FL
National Provider Identifier
1184731739
Registry record updated Oct 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
4494 Issued in FL
Practice address
3196 N Federal Hwy
Boca Raton, FL 33431-6700
Phone
(561) 849-3000
Fax
(800) 708-1338
NPI assigned
Aug 23, 2006
Last updated
Oct 14, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 14, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Foot Surgery Podiatrist 213ES0131X 4494 FL Primary
Foot Surgery Podiatrist 213ES0131X 004379 NY

Addresses

Primary practice location

3196 N Federal Hwy
Boca Raton, FL 33431-6700

Mailing address

11 Plaza Real S Apt 1212
Boca Raton, FL 33432-4869
Phone (203) 442-3121

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231207000785 FL Practitioner - Podiatry 9830293927 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
4494FLMDFoot Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Usai Med LLC CurrentSince Oct 11, 2023 Accepting new patients
Anti-Aging Alliance LLC PastSince Oct 11, 2023 Accepting new patients

Locations

3196 N Federal Hwy
Ste A
Boca Raton, FL 33431
Phone (561) 445-4489

Organizations & group practices 2

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": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697241600000",
    "number": "1184731739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 PLAZA REAL S APT 1212",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334324869",
            "telephone_number": "203-442-3121",
            "fax_number": "800-708-1338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3196 N FEDERAL HWY",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334316700",
            "telephone_number": "561-849-3000",
            "fax_number": "800-708-1338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEWS",
        "first_name": "DANIEL",
        "middle_name": "DE FAZIO",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2023-10-14",
        "certification_date": "2023-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "FL",
            "license": "4494",
            "primary": true
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NY",
            "license": "004379",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

Verify at the official NPI Registry.