Individual provider Active NPI

Michelle Maria Matheson, PA

  • Physician Assistant
  • Johnson City, NY
National Provider Identifier
1235318833
Registry record updated Jul 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
012040 Issued in NY
Practice address
30 Harrison St Ste 455
Johnson City, NY 13790-2176
Phone
(607) 763-8100
Fax
(607) 763-8048
NPI assigned
Oct 31, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 012040 NY
Physician Assistant 363A00000X 012040 NY Primary

Addresses

Primary practice location

30 Harrison St Ste 455
Johnson City, NY 13790-2176

Mailing address

33 Lewis Rd
2ND Floor
Binghamton, NY 13905
Phone (607) 729-8156

Other identifiers 1

IdentifierTypeStateIssuer
03236537MedicaidNY

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080131000088 NY Practitioner - Physician Assistant 0840372736 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10 -24 Mitchell Ave
Binghamton, NY 13903-1617
Phone (607) 762-3131

33 -57 Harrison St
Johnson City, NY 13790-2107
Phone (607) 763-6101

54 Main St
Candor, NY 13743-1619
Phone (607) 659-7272

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.14 of 100Reported as group
Quality
86.74
Promoting interoperability
99
Improvement activities
40
Cost
70.09

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
012040NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
United Health Services Hospitals, Inc. CurrentSince Jan 14, 2014 Accepting new patients
United Medical Associates PC CurrentSince Aug 1, 2016 Accepting new patients

Locations

33 Lewis Rd
Fl 2
Binghamton, NY 13905
Phone (607) 729-8156

30 Harrison St
Ste 455
Johnson City, NY 13790
Phone (607) 763-8100

30 Harrison St
Ste 250
Johnson City, NY 13790
Phone (607) 763-6580

33-57 Harrison St
Johnson City, NY 13790
Phone (607) 763-6412

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1193788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657497600000",
    "number": "1235318833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 LEWIS RD",
            "address_2": "2ND FLOOR",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "13905",
            "telephone_number": "607-729-8156",
            "fax_number": "607-729-3982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 HARRISON ST STE 455",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902176",
            "telephone_number": "607-763-8100",
            "fax_number": "607-763-8048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHESON",
        "first_name": "MICHELLE",
        "middle_name": "MARIA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-31",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "012040",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "012040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03236537",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, NY

Sources for this page

Verify at the official NPI Registry.