Melody A Dematteis

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS044674 Issued in PA

Practice address

116 Seymour St
Blossburg, PA 16912-1418

Phone

(570) 638-2174

NPI assigned

Jul 2, 2024

Last updated

Jul 2, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• North Penn Comprehensive Health Services

  dba Laurel Health Center

  • Federally Qualified Health Center (FQHC)
  • Wellsboro, PA
  • NPI 1912093576
  Medicare reassignment NPD
• North Penn Comprehensive Health Services

  dba Sullivan County Laurel Health Center

  • Federally Qualified Health Center (FQHC)
  • Laporte, PA
  • NPI 1093520587
  NPD
• North Penn Comprehensive Health Services

  dba Laurel Health & Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Mansfield, PA
  • NPI 1609433036
  NPD

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

{
    "created_epoch": "1719878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1508602368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 W WELLSBORO ST",
            "city": "MANSFIELD",
            "state": "PA",
            "postal_code": "169331411",
            "telephone_number": "570-662-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 SEYMOUR ST",
            "city": "BLOSSBURG",
            "state": "PA",
            "postal_code": "169121418",
            "telephone_number": "570-638-2174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMATTEIS",
        "first_name": "MELODY",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-02",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS044674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bloss Pharmacy, Inc. (Bloss Pharmacy)
• Blossburg Firemens Ambulance Association, Inc
• Kathryn G Brodrick, LCSW
• Brandyn M Choplosky, PA-C
• Concern-Professional Services for Children, Youth & Families
• Anthonette Nicole Deprimo, LSW
• Tina Marie Doud-Kearns, FNPC
• Kathryn Kelsey Herrmann, RDH
• Jeffrey Phillip Lemon, RPH
• Jessica Lonzi-McVay, LISW, LCSW

• General Practice Dentistry in Blossburg, PA
• Providers in Blossburg, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.