NPIMap

Individual provider Active NPI

Mathew M Edavettal, MD

  • Surgery Physician
  • Lancaster, PA
National Provider Identifier
1467680454
Registry record updated Jun 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD437555 Issued in PA
Practice address
555 N Duke St
Lancaster, PA 17602-2250
Phone
(717) 544-5511
NPI assigned
Jun 29, 2009
Last updated
Jun 29, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD437555 PA Primary

Addresses

Primary practice location

555 N Duke St
Lancaster, PA 17602-2250

Mailing address

555 N Duke St
Lancaster, PA 17602-2250
Phone (717) 544-5511

Other identifiers 1

IdentifierTypeStateIssuer
MD437555OtherPAPA MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170728003081 AZ Practitioner - General Surgery 6901943398 Reassigns benefits to 1 organization
I20200812001855 FL Practitioner - General Surgery 6901943398 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Louisiana State University School of Medicine in New Orleans, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sacred Heart Health System IncGroup PAC ID 3779491386, 373 clinicians

Practice addresses (Care Compare)

619 N Cove Blvd
Sacred Heart Medical Group
Panama City, FL 32401-3642
Phone (850) 785-9559

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
HRMC, LLC Current Accepting new patients
Sacred Heart Health System, Inc. CurrentSince May 8, 2020 Accepting new patients
Sacred Heart Health System Inc CurrentSince May 8, 2020 Accepting new patients
HRMC, LLC CurrentSince Jun 13, 2017 Accepting new patients
HRMC, LLC CurrentSince Jun 13, 2017 Accepting new patients
Sacred Heart Health System, Inc. Current Accepting new patients

Locations

101 Civic Center Ln
Lk Havasu Cty, AZ 86403
Phone (928) 453-0150

1851 Mesquite Ave
Ste 210
Lk Havasu Cty, AZ 86403
Phone (928) 854-7540

36500 Emerald Coast Pkwy
Destin, FL 32541
Phone (850) 269-0301

26 Racetrack Rd NW
Ft Walton Bch, FL 32547
Phone (850) 416-2340

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

619 N Cove Blvd
Panama City, FL 32401
Phone (850) 785-9559

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

Interoperability endpoints

  • Direct secure messaging: cij7146@yourcarecommunity.org
  • FHIR API: https://api.platform.athenahealth.com/19231/brand/1/csg/1/fhir/r4
  • Direct secure messaging: matthew.edavettal.1@19231.direct.athenahealth.com
  • Direct secure messaging: medavettal19428@direct-lghealth.org

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 4

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": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246233600000",
    "number": "1467680454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 N DUKE ST",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176022250",
            "telephone_number": "717-544-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 N DUKE ST",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176022250",
            "telephone_number": "717-544-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDAVETTAL",
        "first_name": "MATHEW",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-29",
        "last_updated": "2009-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD437555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA MEDICAL LICENSE",
            "identifier": "MD437555",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, PA

Sources for this page

Verify at the official NPI Registry.