NPIMap

Individual provider Active NPI

Michael E Mathieu, M.D.

  • Dermatology Physician
  • Winchester, VA
National Provider Identifier
1215908223
Registry record updated May 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
0101057472 Issued in VA
Practice address
1514 Amherst St
Winchester, VA 22601-2803
Phone
(540) 667-4499
Fax
(540) 722-4172
NPI assigned
Jan 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2008

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 0101057472 VA Primary
Procedural Dermatology Physician 207NS0135X 0101057472 VA
Dermatopathology Physician 207ND0900X 0101057472 VA
Dermatology Physician 207N00000X 20687 WV
Procedural Dermatology Physician 207NS0135X 20687 WV
Dermatopathology Physician 207ND0900X 20687 WV

Addresses

Primary practice location

1514 Amherst St
Winchester, VA 22601-2803

Mailing address

1514 Amherst St
Winchester, VA 22601-2803
Phone (540) 667-4499

Other identifiers 4

IdentifierTypeStateIssuer
005902002MedicaidVA
001717411OtherWVMTST BCBS
452904OtherVAANTHEM BCBS
1000519000MedicaidWV

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

LicenseStateTypeSpecialty
20687WVMDProcedural Dermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Asthma & Allergy Center of the Northern Shenandoah Valley, Inc. Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1138406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211328000000",
    "number": "1215908223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 AMHERST ST",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012803",
            "telephone_number": "540-667-4499",
            "fax_number": "540-722-4172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 AMHERST ST",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012803",
            "telephone_number": "540-667-4499",
            "fax_number": "540-722-4172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIEU",
        "first_name": "MICHAEL",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-28",
        "last_updated": "2008-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VA",
            "license": "0101057472",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "VA",
            "license": "0101057472",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "VA",
            "license": "0101057472",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WV",
            "license": "20687",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "WV",
            "license": "20687",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "WV",
            "license": "20687",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005902002",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MTST BCBS",
            "identifier": "001717411",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "452904",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000519000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winchester, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.