Individual provider Active NPI

Joyamma Mathew

  • Adult Health Nurse Practitioner
  • West Haven, CT
National Provider Identifier
1275137531
Registry record updated Jul 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
9415 Issued in CT
Practice address
687 Campbell Ave
West Haven, CT 06516-3774
Phone
(203) 932-6481
NPI assigned
Nov 27, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X AG11200064 CT
Adult Health Nurse Practitioner 363LA2200X 9415 CT Primary

Addresses

Primary practice location

687 Campbell Ave
West Haven, CT 06516-3774

Mailing address

23 Doris Dr
Monroe, CT 06468-2106
Phone (203) 543-6934

Other practice location 1

950 Campbell Ave
West Haven, CT 06516-2770
Phone (203) 932-5711

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address joyamma.mathew@xdr.hhchealthdirect.org Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20210330001486 CT Practitioner - Nurse Practitioner 4284041799 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AG11200064CTMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jack V. Diteodoro M.D,LLC CurrentSince Nov 18, 2022 Accepting new patients
Stella Medical Care LLC Adult Health CurrentSince Dec 6, 2023 Accepting new patients

Locations

90 Morgan St
Ste 303
Stamford, CT 06905
Phone (203) 323-6873

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.

NPI Registry JSON

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

{
    "created_epoch": "1606435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1275137531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 DORIS DR",
            "city": "MONROE",
            "state": "CT",
            "postal_code": "064682106",
            "telephone_number": "203-543-6934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "687 CAMPBELL AVE",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065163774",
            "telephone_number": "203-932-6481"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "950 Campbell Ave",
            "address_purpose": "LOCATION",
            "city": "West Haven",
            "state": "CT",
            "postal_code": "065162770",
            "country_code": "US",
            "telephone_number": "203-932-5711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "JOYAMMA",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-27",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CT",
            "license": "AG11200064",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CT",
            "license": "9415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "joyamma.mathew@xdr.hhchealthdirect.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "687 Campbell Ave",
            "city": "West Haven",
            "state": "CT",
            "country_code": "US",
            "postal_code": "065163774",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in West Haven, CT

Sources for this page

Verify at the official NPI Registry.