NPIMap

Individual provider Active NPI

Matthew Lewullis, DO

  • Sports Medicine (Family Medicine) Physician
  • Berwyn, PA
National Provider Identifier
1679604979
Registry record updated Jan 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
OS013072 Issued in PA
Practice address
1001 Chesterbrook Boulevard
Berwyn, PA 19312
Phone
(610) 576-7700
Fax
(610) 576-7705
NPI assigned
Mar 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X OS013072 PA Primary
Family Medicine Physician 207Q00000X OS013072 PA
Sports Medicine (Internal Medicine) Physician 207RS0010X OS013072 PA

Addresses

Primary practice location

1001 Chesterbrook Boulevard
Berwyn, PA 19312

Mailing address

1001 Chesterbrook Boulevard
Berwyn, PA 19312
Phone (610) 576-7700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20071029000163 PA Practitioner - Sports MedicinePractitioner - Family Practice 0244327971 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Family Practice
Education
Philadelphia College of Osteopathic Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Novacare Outpatient Rehabilitation East, Inc.Group PAC ID 3678480290, shared by 15 NPIs, 493 clinicians

Practice addresses (Care Compare)

1001 Chesterbrook Blvd
Berwyn, PA 19312-3805
Phone (610) 576-7636

1001 Chesterbrook Blvd FL 3
Specialty Care VF
Berwyn, PA 19312-3805
Phone (610) 576-7500

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

201 2ND Ave
Collegeville, PA 19426-3613
Phone (610) 489-7703

777 Township Line Rd
Suite 200
Yardley, PA 19067-5564
Phone (215) 860-0775

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS013072PAMDSports Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clinical Care Associates of the University of Pennsylvania Health Family Medicine CurrentSince Aug 1, 2010 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health CurrentSince Aug 1, 2010 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health Syst Past Accepting new patients

Locations

1001 Chesterbrook Blvd
Fl 3E
Berwyn, PA 19312

1001 Chesterbrook Blvd
Berwyn, PA 19312
Phone (610) 576-7500

1001 Chesterbrook Blvd
Fl 3
Berwyn, PA 19312
Phone (610) 576-7500

777 Township Line Rd
Ste 200
Yardley, PA 19067
Phone (215) 860-0775

Organizations & group practices 3

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.

Hospital & facility affiliations 9

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": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483660800000",
    "number": "1679604979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 CHESTERBROOK BOULEVARD",
            "city": "BERWYN",
            "state": "PA",
            "postal_code": "19312",
            "telephone_number": "610-576-7700",
            "fax_number": "610-576-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 CHESTERBROOK BOULEVARD",
            "city": "BERWYN",
            "state": "PA",
            "postal_code": "19312",
            "telephone_number": "610-576-7700",
            "fax_number": "610-576-7705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWULLIS",
        "first_name": "MATTHEW",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-08",
        "last_updated": "2017-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "PA",
            "license": "OS013072",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS013072",
            "primary": false
        },
        {
            "code": "207RS0010X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "PA",
            "license": "OS013072",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, PA

Sources for this page

Verify at the official NPI Registry.