Individual provider Active NPI

Marie Dimattia, D.O.

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1407293467
Registry record updated Dec 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS017939 Issued in PA
Practice address
833 Chestnut St Ste 701
Philadelphia, PA 19107-4409
Phone
(215) 955-0735
Fax
(215) 503-9239
NPI assigned
May 31, 2013
Last updated
Dec 13, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 13, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OT-015385 PA
Internal Medicine Physician 207R00000X 3111 WV
Internal Medicine Physician 207R00000X OS017939 PA Primary
Cardiovascular Disease Physician 207RC0000X OS017939 PA

Addresses

Primary practice location

833 Chestnut St Ste 701
Philadelphia, PA 19107-4409

Mailing address

833 Chestnut St Ste 701
Philadelphia, PA 19107-4409
Phone (215) 955-0735

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20170906000888 PA Practitioner - Internal MedicinePractitioner - Hospitalist 0042519654 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Philadelphia College of Osteopathic Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

111 S 11TH St
Philadelphia, PA 19107-4824
Phone (215) 955-6540

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OT-015385PAMDInternal Medicine Physician
3111WVMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Health Access Network, Inc. CurrentSince Apr 10, 2018 Accepting new patients
Prospect Health Access Network, Inc. CurrentSince Apr 10, 2018 Accepting new patients
Jefferson University Physicians Internal Medicine CurrentSince Nov 13, 2018 Accepting new patients
Prospect Health Access Network, Inc. Current Accepting new patients
Tower Health Medical Group Internal Medicine Current Accepting new patients
Tower Health Medical Group CurrentSince Aug 28, 2017 Accepting new patients
Tower Health Medical Group CurrentSince Aug 28, 2017 Accepting new patients
Thomas Jefferson University Hospitals Inc Past Accepting new patients

Locations

1 Medical Center Blvd
Ste 301
Chester, PA 19013
Phone (610) 566-6744

111 S 11th St
Philadelphia, PA 19107
Phone (215) 955-6161

833 Chestnut St
Ste 701
Philadelphia, PA 19107
Phone (215) 955-0735

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

100 W Sproul Rd
Ste 123
Springfield, PA 19064
Phone (610) 619-8281

301 S 7th Ave
Ste 130
West Reading, PA 19611
Phone (610) 988-4630

2610 Keiser Blvd
Wyomissing, PA 19610
Phone (484) 628-9127

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544659200000",
    "number": "1407293467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 CHESTNUT ST STE 701",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074409",
            "telephone_number": "215-955-0735",
            "fax_number": "215-503-9239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 CHESTNUT ST STE 701",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074409",
            "telephone_number": "215-955-0735",
            "fax_number": "215-503-9239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIMATTIA",
        "first_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-31",
        "last_updated": "2018-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OT-015385",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "3111",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS017939",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "PA",
            "license": "OS017939",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.