NPIMap

Individual provider Active NPI

Dwight Fitzgerald Matthias, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Newport News, VA
National Provider Identifier
1609805332
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
0101229098 Issued in VA
Practice address
11803 Jefferson Ave
Port Warwick Medical Arts Suite 236
Newport News, VA 23606-2565
Phone
(757) 594-1072
Fax
(757) 594-1195
NPI assigned
Jul 3, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 0101229098 VA Primary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X A63168 CA

Addresses

Primary practice location

11803 Jefferson Ave
Port Warwick Medical Arts Suite 236
Newport News, VA 23606-2565

Mailing address

PO Box 1345
Chesapeake, VA 23327-1345
Phone (757) 436-0909

Other identifiers 1

IdentifierTypeStateIssuer
0101229098OtherVAVA LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041026000011 VA Practitioner - EndocrinologyPractitioner - Internal Medicine 8123089257 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11803 Jefferson Ave
Suite 260
Newport News, VA 23606-4390
Phone (757) 436-0909

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
23.25 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
77.49

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A63168CAMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Endocrine Consultants, PC Endocrinology, Diabetes & Metabolism CurrentSince Aug 16, 2004 Accepting new patients
Evms Academic Physicians and Surgeons Health Services Foundation Past Accepting new patients

Locations

652 Independence Pkwy
Ste 100
Chesapeake, VA 23320
Phone (757) 436-0909

667 Kingsborough Sq
Ste 300
Chesapeake, VA 23320
Phone (757) 422-5476

11803 Jefferson Ave
Ste 260
Newport News, VA 23606
Phone (757) 436-0909

Interoperability endpoints

  • Direct secure messaging: dwight.matthias.1@17183.direct.athenahealth.com

Organizations & group practices 2

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 8

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": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609805332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1345",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233271345",
            "telephone_number": "757-436-0909",
            "fax_number": "757-436-0169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11803 JEFFERSON AVE",
            "address_2": "PORT WARWICK MEDICAL ARTS SUITE 236",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236062565",
            "telephone_number": "757-594-1072",
            "fax_number": "757-594-1195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTHIAS",
        "first_name": "DWIGHT",
        "middle_name": "FITZGERALD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "VA",
            "license": "0101229098",
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "CA",
            "license": "A63168",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA LICENSE",
            "identifier": "0101229098",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport News, VA

Sources for this page

Verify at the official NPI Registry.