Individual provider Active NPI

Matthew J Anderson, M.D.

  • Emergency Medicine Physician
  • New York, NY
National Provider Identifier
1245458454
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
60 252700 Issued in NY
Practice address
130 E 77TH St
Dept of Emergency Medicine
New York, NY 10075
Phone
(212) 434-3042
NPI assigned
Apr 23, 2007
Last updated
May 24, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 24, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036119361 IL
Emergency Medicine Physician 207P00000X 60 252700 NY Primary

Addresses

Primary practice location

130 E 77TH St
Dept of Emergency Medicine
New York, NY 10075

Mailing address

2800 Marcus Ave
Dept of Emergency Medicine
New Hyde Park, NY 11042-1113
Phone (773) 296-5878

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090910000204 NY Practitioner - Emergency Medicine 8426103789 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Northwestern University Feinberg Medical School, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

100 E 77TH St
New York, NY 10075-1850
Phone (212) 434-2606

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60 252700NYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC Emergency Medicine CurrentSince Jul 23, 2015 Accepting new patients
Advocate North Side Health Network Past Accepting new patients

Locations

300 Community Dr
Manhasset, NY 11030

2800 Marcus Ave
New Hyde Park, NY 11042
Phone (516) 622-6131

100 E 77th St
#2
New York, NY 10075
Phone (212) 434-2460

1000 10th Ave
New York, NY 10019
Phone (212) 523-2369

130 E 77th St
New York, NY 10075
Phone (212) 434-2606

972 Brush Hollow Rd
Westbury, NY 11590

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: manderson65076@northwell.direct-ci.com

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.

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": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684886400000",
    "number": "1245458454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 MARCUS AVE",
            "address_2": "DEPT OF EMERGENCY MEDICINE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421113",
            "telephone_number": "773-296-5878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 E 77TH ST",
            "address_2": "DEPT OF EMERGENCY MEDICINE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10075",
            "telephone_number": "212-434-3042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MATTHEW",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036119361",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "60 252700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.