Individual provider Active NPI

Maria Chakkalamuriyil Mathew

  • Medical Physician Assistant
  • Doylestown, PA
National Provider Identifier
1508681222
Registry record updated Jun 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
OA007758 Issued in PA
Practice address
1456 Ferry Rd Ste 403
Doylestown, PA 18901-2306
Phone
(267) 614-0530
NPI assigned
Nov 18, 2024
Last updated
Jun 17, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X OA007758 PA Primary

Addresses

Primary practice location

1456 Ferry Rd Ste 403
Doylestown, PA 18901-2306

Mailing address

1456 Ferry Rd Ste 403
Doylestown, PA 18901-2306
Phone (267) 614-0530

Other practice location 1

29200 Harper Ave
Saint Clair Shores, MI 48081-1274
Phone (586) 777-7577

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250509001287 MI Practitioner - Physician Assistant 0840717120 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shores Rheumatology PCGroup PAC ID 3577596311, 6 clinicians

Practice addresses (Care Compare)

29200 Harper Ave
Saint Clair Shores, MI 48081-1274
Phone (586) 777-7577

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601012776MIMDMedical Physician Assistant

Interoperability endpoints

  • Direct secure messaging: mmathew3171855@epic00.corewelldirect.org

Organizations & group practices 1

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 5

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": "1731888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781654400000",
    "number": "1508681222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1456 FERRY RD STE 403",
            "city": "DOYLESTOWN",
            "state": "PA",
            "postal_code": "189012306",
            "telephone_number": "267-614-0530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1456 FERRY RD STE 403",
            "city": "DOYLESTOWN",
            "state": "PA",
            "postal_code": "189012306",
            "telephone_number": "267-614-0530"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29200 Harper Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Clair Shores",
            "state": "MI",
            "postal_code": "480811274",
            "country_code": "US",
            "telephone_number": "586-777-7577",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "MARIA",
        "middle_name": "CHAKKALAMURIYIL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-18",
        "last_updated": "2026-06-17",
        "certification_date": "2026-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "OA007758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Doylestown, PA

Sources for this page

Verify at the official NPI Registry.