Kallukalam Joseph Mathew, M.D.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

D0014799 Issued in MD

Practice address

6504 Kenilworth Ave
Suite 200
Riverdale, MD 20737-1386

Phone

(301) 927-8011

Fax

(301) 699-1584

NPI assigned

May 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24726/brand/1/csg/1/fhir/r4

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.

• Riverside Medical Associates PA

  • Endocrinology, Diabetes & Metabolism Physician
  • Riverdale, MD
  • NPI 1730132648

  Cardiovascular Disease, DC

  Medicare reassignment NPD
• Riverdale Radiology, LLC

  • Diagnostic Radiology Physician
  • Riverdale, MD
  • NPI 1255379343
  NPD (past)

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406764800000",
    "number": "1720033392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6504 KENILWORTH AVE",
            "address_2": "SUITE 200",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371386",
            "telephone_number": "301-927-8011",
            "fax_number": "301-699-1584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6504 KENILWORTH AVE",
            "address_2": "SUITE 200",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371386",
            "telephone_number": "301-927-8011",
            "fax_number": "301-699-1584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "KALLUKALAM",
        "middle_name": "JOSEPH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2014-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MD",
            "license": "D0014799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060042761",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana Martinez, FNP
• Gisela Martinez, LCSW-C
• Maryland CVS Pharmacy, L.L.C.
• Delphine Elomba Masango
• Vilma Mascarenhas, M.D.
• Veronica Remi Mayowa
• Marie Asob Mbah Epse Teboh
• Armstrong Mbah Mbah
• Holy Mbah
• Roland Mbah Mbah

• Cardiovascular Disease Physician in Riverdale, MD
• Providers in Riverdale, MD by specialty
• Cardiovascular Disease Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.