Active NPI
Jacob Mathew, MD
- Anesthesiology Physician
- Merrillville, IN
National Provider Identifier
1205973476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 01028065A
- Practice address
- 255 East 90 Dr
Merrillville, IN 46410 - Phone
- (219) 791-0500
- Fax
- (219) 791-0566
- NPI assigned
- Jan 30, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 01028065A | IN | Primary |
Addresses
Primary practice location
255 East 90 Dr
Merrillville, IN 46410
Mailing address
731 Cirque CT
Crown Point, IN 46307
Phone (219) 810-8327
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01028065A | IN | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205973476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "731 CIRQUE CT",
"city": "CROWN POINT",
"state": "IN",
"postal_code": "46307",
"telephone_number": "219-810-8327",
"fax_number": "219-310-8327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 EAST 90 DR",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "46410",
"telephone_number": "219-791-0500",
"fax_number": "219-791-0566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHEW",
"first_name": "JACOB",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "IN",
"license": "01028065A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Merrillville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.