Randy C Mathewson, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

23146 Issued in WI

Practice address

6601 Northway # D
Greendale, WI 53129-1830

Phone

(414) 423-0555

Fax

(414) 423-8268

NPI assigned

Sep 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Greendale Medical Clinic, S.C.

  • Internal Medicine Physician
  • Greendale, WI
  • NPI 1023119666
  NPD

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1477654002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5745 GLADSTONE LN",
            "city": "GREENDALE",
            "state": "WI",
            "postal_code": "531291512",
            "telephone_number": "414-423-0555",
            "fax_number": "414-423-8268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 NORTHWAY # D",
            "city": "GREENDALE",
            "state": "WI",
            "postal_code": "531291830",
            "telephone_number": "414-423-0555",
            "fax_number": "414-423-8268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEWSON",
        "first_name": "RANDY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "23146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30436400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luxottica Retail North America Inc
• Darin A Maccoux, MD
• Teri Maduscha
• Jennifer Maikowski, PT
• Anne Marie Markofski, SLP
• Tony J Matuszak, O.D
• Kelley McCarthy
• Mary Eileen McDonough, AU.D.
• Terry Lee McMillan, M.D.
• Amy A Medrano, APNP

• Internal Medicine Physician in Greendale, WI
• Providers in Greendale, WI by specialty
• Internal Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.