Individual provider Active NPI

Mary Mattheos, M.D.

  • Internal Medicine Physician
  • Lindenhurst, NY
National Provider Identifier
1609977719
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
161119-1 Issued in NY
Practice address
350 W Montauk Hwy
Lindenhurst, NY 11757-5630
Phone
(631) 226-0388
Fax
(631) 226-2992
NPI assigned
Sep 25, 2006
Last updated
Oct 31, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 161119-1 NY Primary

Addresses

Primary practice location

350 W Montauk Hwy
Lindenhurst, NY 11757-5630

Mailing address

350 W Montauk Hwy
Lindenhurst, NY 11757-5630
Phone (631) 226-0388

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041112001120 NY Practitioner - Internal Medicine 3779547435 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mary Mattheos Physician, PCGroup PAC ID 9335160423, 2 clinicians

Practice addresses (Care Compare)

350 W Montauk Hwy
Lindenhurst, NY 11757-5630
Phone (631) 226-0388

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
161119-1NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Mattheos Physician P.C. Internal Medicine CurrentSince Aug 5, 1997 Accepting new patients

Locations

350 W Montauk Hwy
Lindenhurst, NY 11757
Phone (631) 226-0388

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 4

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": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1609977719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 W MONTAUK HWY",
            "city": "LINDENHURST",
            "state": "NY",
            "postal_code": "117575630",
            "telephone_number": "631-226-0388",
            "fax_number": "631-226-2992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W MONTAUK HWY",
            "city": "LINDENHURST",
            "state": "NY",
            "postal_code": "117575630",
            "telephone_number": "631-226-0388",
            "fax_number": "631-226-2992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTHEOS",
        "first_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "161119-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lindenhurst, NY

Sources for this page

Verify at the official NPI Registry.