Individual provider Active NPI

Eddie Mathis, MD

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1740292598
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
6138 Issued in NV
Practice address
4475 S Eastern Ave Ste 1300
Las Vegas, NV 89119-7826
Phone
(702) 243-8500
Fax
(702) 363-8753
NPI assigned
Aug 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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 6138 NV Primary

Addresses

Primary practice location

4475 S Eastern Ave Ste 1300
Las Vegas, NV 89119-7826

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 243-8500

Other identifiers 1

IdentifierTypeStateIssuer
1740292598MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20070110000194 NV Practitioner - Emergency Medicine 2466429428 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Tennessee, HSC, College of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optum Medical Group II Rhodes P CGroup PAC ID 4981687779, 296 clinicians

Practice addresses (Care Compare)

2845 Siena Heights Dr
Henderson, NV 89052-4153
Phone (702) 579-3253

4475 S Eastern Ave
Las Vegas, NV 89119-7826
Phone (702) 579-3253

7061 Grand Montecito Pkwy
Las Vegas, NV 89149-0287
Phone (702) 579-3253

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Group Rhodes P C CurrentSince Jun 8, 2019 Accepting new patients
Southwest Medical Associates, Inc CurrentSince Dec 3, 2007 Accepting new patients
Optum Medical Group II Rhodes P C CurrentSince Jun 8, 2019 Accepting new patients
Linda L. Johnson MD, LTD Past Accepting new patients
Nopah Vista Emergency Physicians LLC Past Accepting new patients

Locations

300 E Lake Mead Pkwy
Henderson, NV 89015
Phone (702) 435-4301

4475 S Eastern Ave
Ste 1300
Las Vegas, NV 89119
Phone (702) 243-8500

2704 N Tenaya Way
Las Vegas, NV 89128
Phone (702) 243-8500

420 N Nellis Blvd
Las Vegas, NV 89110
Phone (702) 339-5710

2316 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 877-8330

Interoperability endpoints

  • Direct secure messaging: emathis119271@westdirect.optum.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1740292598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-243-8500",
            "fax_number": "702-363-8753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4475 S EASTERN AVE STE 1300",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891197826",
            "telephone_number": "702-243-8500",
            "fax_number": "702-363-8753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "EDDIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "6138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740292598",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.