Active NPI
Jane M Mathisen, MD
- Psychiatry Physician
- Bala Cynwyd, PA
National Provider Identifier
1679632616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD036291E
- Practice address
- 1 Bala Ave
Suite 118
Bala Cynwyd, PA 19004-3207 - Phone
- (610) 667-2557
- Fax
- (610) 667-2445
- NPI assigned
- Dec 6, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD036291E | PA | Primary |
Addresses
Primary practice location
1 Bala Ave
Suite 118
Bala Cynwyd, PA 19004-3207
Mailing address
445 Rockland Rd
Merion Station, PA 19066-1354
Phone (610) 667-6806
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2023 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679632616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "445 ROCKLAND RD",
"city": "MERION STATION",
"state": "PA",
"postal_code": "190661354",
"telephone_number": "610-667-6806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BALA AVE",
"address_2": "SUITE 118",
"city": "BALA CYNWYD",
"state": "PA",
"postal_code": "190043207",
"telephone_number": "610-667-2557",
"fax_number": "610-667-2445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHISEN",
"first_name": "JANE",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "MD036291E",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bala Cynwyd, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.