NPIMap

Individual provider Active NPI

Edwin Roy Mathews, DO

  • Internal Medicine Physician
  • Jacksonville, IL
National Provider Identifier
1225657125
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036.165011 Issued in IL
Practice address
15 Founders LN Ste 100
Jacksonville, IL 62650-3924
Phone
(217) 243-0300
Fax
(217) 245-6775
NPI assigned
Apr 10, 2020
Last updated
Oct 23, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036.165011 IL Primary

Addresses

Primary practice location

15 Founders LN Ste 100
Jacksonville, IL 62650-3924

Mailing address

15 Founders LN Ste 100
Jacksonville, IL 62650-3924
Phone (217) 243-0300

Other identifiers 1

IdentifierTypeStateIssuer
036.165011OtherILMD LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230830002147 IL Practitioner - Internal Medicine 0648694448 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Physician ServicesGroup PAC ID 9032005681, 161 clinicians

Practice addresses (Care Compare)

101 E Plummer Blvd
Chatham, IL 62629-8047
Phone (217) 588-2600

15 Founders St
Suite 100
Jacksonville, IL 62650-3918
Phone (217) 243-0300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.44 of 100Reported as group
Quality
71.79
Promoting interoperability
77
Improvement activities
40
Cost
75.71

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.165011ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Springfield Clinic LLP Current Accepting new patients
Memorial Physician Services Internal Medicine CurrentSince Aug 31, 2023 Accepting new patients
Memorial Physician Services Current Accepting new patients
Memorial Physician Services CurrentSince Aug 31, 2023 Accepting new patients
Family Medical Center of Chatham, LLC Current Accepting new patients
Memorial Physician Services Past Accepting new patients

Locations

101 E Plummer Blvd
Chatham, IL 62629
Phone (217) 483-3487

15 Founders Ln
Ste 100
Jacksonville, IL 62650
Phone (217) 243-0300

Interoperability endpoints

  • Direct secure messaging: edwinmathews@sfc.allscriptsdirect.net

Organizations & group practices 7

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1586476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1225657125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 FOUNDERS LN STE 100",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626503924",
            "telephone_number": "217-243-0300",
            "fax_number": "217-245-6775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 FOUNDERS LN STE 100",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626503924",
            "telephone_number": "217-243-0300",
            "fax_number": "217-245-6775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEWS",
        "first_name": "EDWIN",
        "middle_name": "ROY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-10",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.165011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD LICENSE",
            "identifier": "036.165011",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, IL

Sources for this page

Verify at the official NPI Registry.