NPIMap

Individual provider Active NPI

Matthew Dale Chetta, M.D.

  • Plastic Surgery Physician
  • Greenville, SC
National Provider Identifier
1689802704
Registry record updated Nov 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
88707 Issued in SC
Practice address
200 Patewood Dr Ste B480
Greenville, SC 29615-6327
Phone
(864) 454-4570
Fax
(864) 454-4575
NPI assigned
Jun 26, 2009
Last updated
Nov 15, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 35134127 OH
Plastic Surgery Physician 208200000X 88707 SC Primary

Addresses

Primary practice location

200 Patewood Dr Ste B480
Greenville, SC 29615-6327

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842

Other practice location 1

915 Olentangy River Rd
Columbus, OH 43212
Phone (614) 293-8566

Other practice location 2

915 Olentangy River Rd
Columbus, OH 43212
Phone (614) 293-8566

Other identifiers 2

IdentifierTypeStateIssuer
0322265MedicaidOH
PENDINGMedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mchetta658104@direct.osumc.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20221129000705 SC Practitioner - Plastic and Reconstructive Surgery 3072741529 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Medical College of Georgia School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

200 Patewood Dr
Suite B480
Greenville, SC 29615-6327
Phone (864) 454-4570

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy22
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
132971CAMDSocial Worker
88707SCMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Dec 5, 2022 Accepting new patients
Prisma Health University Medical Group CurrentSince Dec 5, 2022 Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

200 Patewood Dr
Ste B480
Greenville, SC 29615
Phone (864) 454-4200

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

Interoperability endpoints

  • Direct secure messaging: mchetta625013@direct.ghs.myhfn.org
  • Direct secure messaging: mchetta658104@direct.osumc.edu

Organizations & group practices 2

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 48

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1245974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668470400000",
    "number": "1689802704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR STE B480",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296156327",
            "telephone_number": "864-454-4570",
            "fax_number": "864-454-4575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "915 Olentangy River Rd",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "43212",
            "country_code": "US",
            "telephone_number": "614-293-8566",
            "fax_number": "614-293-3381",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "915 Olentangy River Rd",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "43212",
            "country_code": "US",
            "telephone_number": "614-293-8566",
            "fax_number": "614-293-3381",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHETTA",
        "first_name": "MATTHEW",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-26",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "OH",
            "license": "35134127",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "SC",
            "license": "88707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0322265",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mchetta658104@direct.osumc.edu",
            "affiliation": "N",
            "address_1": "915 Olentangy River Rd",
            "city": "Columbus",
            "state": "OH",
            "country_code": "US",
            "postal_code": "43212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.