Chris Gus Dematatis, CHRIS DEMATATIS

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

PS-003889-L Issued in PA

Practice address

191 Presidential Blvd
Suite 124
Bala Cynwyd, PA 19004-1207

Phone

(610) 667-5829

Fax

(610) 667-3438

NPI assigned

Jan 8, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Chris Gus Dematatis Professional name

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Michigan State University College of Human Medicine, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295883320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 PRESIDENTIAL BLVD",
            "address_2": "SUITE 124",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041207",
            "telephone_number": "610-667-5829",
            "fax_number": "610-667-3438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 PRESIDENTIAL BLVD",
            "address_2": "SUITE 124",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041207",
            "telephone_number": "610-667-5829",
            "fax_number": "610-667-3438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMATATIS",
        "first_name": "CHRIS",
        "middle_name": "GUS",
        "name_prefix": "Dr.",
        "credential": "CHRIS DEMATATIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "PA",
            "license": "PS-003889-L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "PS-003889-L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRIS",
            "last_name": "DEMATATIS",
            "middle_name": "GUS",
            "prefix": "DR.",
            "credential": "CHRIS DEMATATIS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Counseling Psychologist in Bala Cynwyd, PA
• Providers in Bala Cynwyd, PA by specialty
• Counseling Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.