Individual provider Active NPI

Jason Earl Matherne, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Beaumont, TX
National Provider Identifier
1679670681
Registry record updated Dec 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
L3744 Issued in TX
Practice address
3530 Fannin St
Beaumont, TX 77701-3805
Phone
(409) 842-8222
Fax
(409) 842-8244
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X L3744 TX Primary

Addresses

Primary practice location

3530 Fannin St
Beaumont, TX 77701-3805

Mailing address

3530 Fannin St
Beaumont, TX 77701-3805
Phone (409) 842-8222

Other identifiers 6

IdentifierTypeStateIssuer
152655003MedicaidTX
121679805MedicaidTX
121679801MedicaidTX
N0123265OtherTXDPS
121679802MedicaidTX
152655004MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20040810001034 TX Practitioner - Pathology 5395717383 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Texas Medical School at Houston, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3530 Fannin St
Beaumont, TX 77701-3805
Phone (409) 842-8222

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L3744TXMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Diagnostic Pathology Associates, LLP Anatomic Pathology & Clinical Pathology CurrentSince Aug 1, 2004 Accepting new patients
Diagnostic Pathology Associates, LLP Anatomic Pathology & Clinical Pathology CurrentSince Aug 1, 2004 Accepting new patients
Ameripath Lubbock 5.01(a) Corporation Past Accepting new patients
Arlington Pathology Association 501a Corporation Past Accepting new patients
Ameripath Lubbock 5.01(a) Corporation Anatomic Pathology & Clinical Pathology Past Accepting new patients

Locations

3080 College St
Beaumont, TX 77701
Phone (409) 212-5000

3530 Fannin St
Beaumont, TX 77701
Phone (409) 842-8222

608 Strickland Dr
Orange, TX 77630
Phone (409) 883-1248

Organizations & group practices 5

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 2

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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323993600000",
    "number": "1679670681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3530 FANNIN ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777013805",
            "telephone_number": "409-842-8222",
            "fax_number": "409-842-8244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3530 FANNIN ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777013805",
            "telephone_number": "409-842-8222",
            "fax_number": "409-842-8244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHERNE",
        "first_name": "JASON",
        "middle_name": "EARL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2011-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TX",
            "license": "L3744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152655003",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121679805",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121679801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DPS",
            "identifier": "N0123265",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121679802",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152655004",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaumont, TX

Sources for this page

Verify at the official NPI Registry.