Individual provider Active NPI

Maryann Dematthews, MS, LMFT

  • Marriage & Family Therapist
  • Geneva, IL
National Provider Identifier
1720402845
Registry record updated Dec 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
166.001247 Issued in IL
Practice address
825 W State St Ste 103D
Geneva, IL 60134-2078
Phone
(331) 223-0330
NPI assigned
Feb 10, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 166.001247 IL Primary

Addresses

Primary practice location

825 W State St Ste 103D
Geneva, IL 60134-2078

Mailing address

825 W State St Ste 103D
Geneva, IL 60134-2078
Phone (331) 223-0330

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240719003111 IL Practitioner - Marriage and Family Therapist 9638615123 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

825 W State St
Suite 103D
Geneva, IL 60134-2078
Phone (331) 223-0286

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
166.001247ILMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Pearl Counseling LLC Marriage & Family Therapist CurrentSince Feb 26, 2019 Accepting new patients

Locations

825 W State St
Ste 103D
Geneva, IL 60134
Phone (331) 223-0286

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1391990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671753600000",
    "number": "1720402845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 W STATE ST STE 103D",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601342078",
            "telephone_number": "331-223-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 W STATE ST STE 103D",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601342078",
            "telephone_number": "331-223-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMATTHEWS",
        "first_name": "MARYANN",
        "credential": "MS, LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-10",
        "last_updated": "2022-12-23",
        "certification_date": "2022-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "166.001247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Geneva, IL

Sources for this page

Verify at the official NPI Registry.