Active NPI
John Lyle Matthews, M.D.
- Child & Adolescent Psychiatry Physician
- Raleigh, NC
National Provider Identifier
1548308471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 95-01331
- Practice address
- 3725 National Dr
Suite 227
Raleigh, NC 27612-4066 - Phone
- (919) 786-0055
- Fax
- (919) 786-1337
- NPI assigned
- Feb 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 95-01331 | NC | Primary |
Addresses
Primary practice location
3725 National Dr
Suite 227
Raleigh, NC 27612-4066
Mailing address
11 Cobbleridge CT
Durham, NC 27713-9493
Phone (919) 419-0113
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225G | Other | BCBS | |
| 891225G | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95-01331 | NC | MD | Child & Adolescent Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Johnston County Public Health Department | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- State or Local Public Health Clinic/Center
- Smithfield, NC
- NPI 1528157211
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208649600000",
"number": "1548308471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 COBBLERIDGE CT",
"city": "DURHAM",
"state": "NC",
"postal_code": "277139493",
"telephone_number": "919-419-0113",
"fax_number": "919-786-1337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3725 NATIONAL DR",
"address_2": "SUITE 227",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276124066",
"telephone_number": "919-786-0055",
"fax_number": "919-786-1337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTHEWS",
"first_name": "JOHN",
"middle_name": "LYLE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2008-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "NC",
"license": "95-01331",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "1225G",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "891225G",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.