NPIMap

Individual provider Active NPI

Allen Sebastian Mathew, MD

  • Nephrology Physician
  • Eureka, CA
National Provider Identifier
1417053075
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
G84898 Issued in CA
Practice address
2316 Harrison Ave
Eureka, CA 95501-3217
Phone
(707) 444-2534
Fax
(707) 441-0344
NPI assigned
Sep 14, 2006
Last updated
Apr 23, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X G84898 CA Primary

Addresses

Primary practice location

2316 Harrison Ave
Eureka, CA 95501-3217

Mailing address

2316 Harrison Ave
Eureka, CA 95501-3217
Phone (707) 444-2534

Other identifiers 1

IdentifierTypeStateIssuer
00G848980MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20080519000725 CA Practitioner - NephrologyPractitioner - Internal Medicine 5193727071 Practice locations: Eureka, CA

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
University of Missouri, Columbia School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2316 Harrison Ave
Eureka, CA 95501-3217
Phone (707) 444-2534

2765 Timber Ridge LN
Eureka, CA 95503-4885
Phone (707) 444-2534

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G84898CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bio-Medical Applications of Eureka, Inc. CurrentSince Dec 6, 2020 Accepting new patients
Allen S Mathew MD Nephrology CurrentSince Aug 1, 2011 Accepting new patients
Eureka Internal Medicine PastSince Apr 30, 2003 Accepting new patients
Kidney Care Services of Humboldt Nephrology PastSince Sep 30, 2020 Accepting new patients
Quantum Healthcare Medical Associates Inc. Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients

Locations

2316 Harrison Ave
Eureka, CA 95501
Phone (707) 442-0478

2505 Lucas St
Eureka, CA 95501
Phone (707) 443-2293

2505 Lucas St
#A
Eureka, CA 95501
Phone (707) 442-0380

2765 Timber Ridge Ln
Eureka, CA 95503
Phone (707) 444-2534

Interoperability endpoints

  • Direct secure messaging: allen.mathew.1@33110.direct.athenahealth.com
  • Direct secure messaging: amathew29290@direct.acumenmd.com
  • FHIR API: https://api.platform.athenahealth.com/15882/brand/1/csg/1/fhir/r4

Organizations & group practices 6

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 9

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": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1417053075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2316 HARRISON AVE",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955013217",
            "telephone_number": "707-444-2534",
            "fax_number": "707-441-0344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2316 HARRISON AVE",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955013217",
            "telephone_number": "707-444-2534",
            "fax_number": "707-441-0344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "ALLEN",
        "middle_name": "SEBASTIAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "G84898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G848980",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eureka, CA

Sources for this page

Verify at the official NPI Registry.