Organization Active NPI

Second Mountain Internal Medicine P.C.

  • Internal Medicine Physician
  • Hebron, ME
National Provider Identifier
1629969332
Registry record updated Jul 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SECOND MOUNTAIN INTERNAL MEDICINE P.C.
Practice address
758 Buckfield Rd
Hebron, ME 04238-3261
Phone
(860) 305-3438
NPI assigned
Jul 11, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2025

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

Authorized official

Name
Dr. John Charles Matulis III, DO, MPHNPI 1891013140
Title
Physician Owner
Phone
(860) 305-3438

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

758 Buckfield Rd
Hebron, ME 04238-3261

Mailing address

758 Buckfield Rd
Hebron, ME 04238-3261

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250820001994 ME Part B Supplier - Clinic/Group Practice 1052810520 Receives reassigned benefits from 1 practitioner
Practice locations: Hebron, ME

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1752192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753833600000",
    "number": "1629969332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "758 BUCKFIELD RD",
            "city": "HEBRON",
            "state": "ME",
            "postal_code": "042383261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "758 BUCKFIELD RD",
            "city": "HEBRON",
            "state": "ME",
            "postal_code": "042383261",
            "telephone_number": "860-305-3438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND MOUNTAIN INTERNAL MEDICINE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-11",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A",
        "authorized_official_last_name": "MATULIS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "860-305-3438",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DO, MPH"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hebron, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.