NPIMap

Individual provider Active NPI

Renee Jennifer Mathur, MD

  • Dermatology Physician
  • Johnstown, PA
National Provider Identifier
1376531970
Registry record updated May 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD064636L Issued in PA
Practice address
913 Menoher Blvd
Johnstown, PA 15905-2834
Phone
(814) 288-2669
Fax
(814) 288-2667
NPI assigned
Oct 9, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 24, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MD064636L PA Primary

Addresses

Primary practice location

913 Menoher Blvd
Johnstown, PA 15905-2834

Mailing address

913 Menoher Blvd
Johnstown, PA 15905-2834
Phone (814) 288-2669

Other identifiers 1

IdentifierTypeStateIssuer
0017037110008MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041202000417 PA Practitioner - Dermatology 5395701270 Reassigns benefits to 1 organization
Receives reassigned benefits from 1 practitioner
Practice locations: Johnstown, PA

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Harvard Medical School, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

1155 E Mountain Blvd
Wilkes Barre, PA 18702-7906
Phone (570) 808-5135

Hospital & facility affiliations

  • Geisinger Wyoming Valley Medical Center Hospital, Wilkes Barre, PA, CCN 390270

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions361
Skin biopsy71

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD064636LPAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Oct 15, 2018 Accepting new patients
Geisinger Clinic CurrentSince Oct 15, 2018 Accepting new patients
Mathur Health Care Past Accepting new patients
Windber Hospital, Inc. Past Accepting new patients
Renee J Mathur MD Dermatology PastSince Jan 1, 1990 Accepting new patients
Geisinger Clinic Past Accepting new patients

Locations

503 N 21st St
Camp Hill, PA 17011
Phone (717) 763-2100

100 N Academy Ave
Danville, PA 17822

3 W Olive St
Scranton, PA 18508
Phone (570) 207-4054

Interoperability endpoints

  • Direct secure messaging: rmathur170780@direct.geisinger.edu

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Organizations & group practices 7

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.

Hospital & facility affiliations 20

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1128816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369353600000",
    "number": "1376531970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 MENOHER BLVD",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159052834",
            "telephone_number": "814-288-2669",
            "fax_number": "814-288-2667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 MENOHER BLVD",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159052834",
            "telephone_number": "814-288-2669",
            "fax_number": "814-288-2667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHUR",
        "first_name": "RENEE",
        "middle_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-09",
        "last_updated": "2013-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD064636L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017037110008",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnstown, PA

Sources for this page

Verify at the official NPI Registry.