Ryan D. Matherly, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01027540A Issued in IN

Practice address

2115 W Lexington Ave
Elkhart, IN 46514-1423

Phone

(574) 296-3955

Fax

(574) 296-3999

NPI assigned

May 27, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Privia Medical Group Indiana, LLC

  • Multi-Specialty Clinic/Center
  • Elkhart, IN
  • NPI 1013912286

  IN

  Medicare reassignment NPD
• Privia Medical Group Indiana, LLC

  • Ophthalmology Physician
  • Elkhart, IN
  • NPI 1013380526
  NPD
• Privia Medical Group Indiana, LLC

  • Family Nurse Practitioner
  • Wakarusa, IN
  • NPI 1568147809
  NPD

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287446400000",
    "number": "1356344972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2968",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465152968",
            "telephone_number": "574-296-3955",
            "fax_number": "574-296-3999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 W LEXINGTON AVE",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465141423",
            "telephone_number": "574-296-3955",
            "fax_number": "574-296-3999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHERLY",
        "first_name": "RYAN",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2010-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01027540A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100112400A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ralph Martinez, RBT
• Allis I. Martz, COTA
• Jocelyn Nichelle Marzini
• Andrew M Mashala, OTR/L
• Andrew Mast
• Doris R. Mathew, LMHC
• Charles A Mathis, MD
• Joshua Matthews, RBT
• James P Mauck Jr., MD
• Jason Elliott Maxwell, DDS

• Family Medicine Physician in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.