NPIMap

Individual provider Active NPI

Eric Mathis, DO

  • Family Medicine Physician
  • Lawton, OK
National Provider Identifier
1699238105
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
7011 Issued in OK
Practice address
3401 W Gore Blvd
Lawton, OK 73505-6332
Phone
(580) 585-5545
NPI assigned
Apr 11, 2019
Last updated
Sep 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 7011 OK Primary

Addresses

Primary practice location

3401 W Gore Blvd
Lawton, OK 73505-6332

Mailing address

2403 W Main St
Henryetta, OK 74437-3893

Other practice location 1

6255 Rock Dove Ave
Las Vegas, NV 89122-3541
Phone (435) 705-6175

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210720003967 TX Practitioner - Family Practice 0648673293 Reassigns benefits to 1 organization
I20220722000962 OK Practitioner - Family Practice 0648673293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ahs Henryetta Hospital LLCGroup PAC ID 9638143282, 4 clinicians

Practice addresses (Care Compare)

2401 W Main St
Henryetta, OK 74437-3893
Phone (918) 652-4463

2403 W Main St
Henryetta, OK 74437-3893
Phone (918) 652-9650

2405 W Main St a
Utica Park Clinic Primary Care
Henryetta, OK 74437-3893
Phone (918) 650-1180

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ahs Henryetta Hospital LLC CurrentSince Jul 1, 2022 Accepting new patients
Ahs Henryetta Hospital LLC Current Accepting new patients
Lawton Indian Hospital CurrentSince Jul 15, 2021 Accepting new patients
Ahs Henryetta Hospital LLC CurrentSince Jul 1, 2022 Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

2401 W Main St
Henryetta, OK 74437
Phone (918) 650-1100

2403 W Main St
Henryetta, OK 74437
Phone (918) 652-6950

1515 NE Lawrie Tatum Rd
Lawton, OK 73507
Phone (580) 353-0350

1145 S Utica Ave
Ste 110
Tulsa, OK 74104
Phone (918) 579-3825

Interoperability endpoints

  • Direct secure messaging: emathis471164@ahs.direct-ci.com

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 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": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1699238105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2403 W MAIN ST",
            "city": "HENRYETTA",
            "state": "OK",
            "postal_code": "744373893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056332",
            "telephone_number": "580-585-5545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6255 Rock Dove Ave",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891223541",
            "country_code": "US",
            "telephone_number": "435-705-6175",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "ERIC",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-11",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "7011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

Verify at the official NPI Registry.