Active NPI
Matthew Faller, MD
- Anesthesiology Physician
- Portsmouth, VA
National Provider Identifier
1376048298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 0101267548
- Practice address
- 620 John Paul Jones Cir
Portsmouth, VA 23708-2111 - Phone
- (618) 979-1561
- NPI assigned
- Mar 25, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Anesthesiology Physician | 207L00000X | 0101267548 | VA | Primary |
Addresses
Primary practice location
620 John Paul Jones Cir
Portsmouth, VA 23708-2111
Mailing address
Naval Medical Center San Diego 38400 Bob Wilson Dr
San Diego, CA 92134-5000
Phone (618) 979-1561
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260622000943 | IL | Practitioner - Anesthesiology | 8022581180 |
Care Compare profile
Medicare Care Compare- Specialty
- Anesthesiology
- Education
- Other, 2018
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
PO Box
Springfield, IL 62708
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101267548 | VA | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704585600000",
"number": "1376048298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "NAVAL MEDICAL CENTER SAN DIEGO 38400 BOB WILSON DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921345000",
"telephone_number": "618-979-1561"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 JOHN PAUL JONES CIR",
"city": "PORTSMOUTH",
"state": "VA",
"postal_code": "237082111",
"telephone_number": "618-979-1561"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FALLER",
"first_name": "MATTHEW",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-03-25",
"last_updated": "2024-01-07",
"certification_date": "2023-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "VA",
"license": "0101267548",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portsmouth, VA
- Fair Winds Therapy & Consulting Services, LLC
- Clinton Forrest Faison III, M.D.
- Faithful Medical Transportation LLC
- Faithful, Love, and Gentle Hands Home Care LLC
- Laura Fales
- Ann Patricia Fallon, M.D., M.P.H.
- Families in New Direction, Inc.
- Family Care Transportation
- Family Solutions, Inc
- Family Solutions, Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2024; 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.