Matthew Robert Dettra, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

455 Pennsylvania Ave Ste 127
Fort Washington, PA 19034-3409

Phone

(215) 793-9755

Fax

(215) 412-3587

NPI assigned

Jun 13, 2019

Last updated

May 25, 2023By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology and Cosmetic Surgery Institute PCGroup PAC ID 2466519343, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Dermatology and Cosmetic Surgery Institute, PC

  • MOHS-Micrographic Surgery Physician
  • Fort Washington, PA
  • NPI 1043485600
  Medicare reassignment Care Compare group
• Nathan R. Howe, MD

  • MOHS-Micrographic Surgery Physician
  • Fort Washington, PA
  • NPI 1659546497
  NPD (past)

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

{
    "created_epoch": "1560384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1760041636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 PENNSYLVANIA AVE STE 127",
            "city": "FORT WASHINGTON",
            "state": "PA",
            "postal_code": "190343409",
            "telephone_number": "215-793-9755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 PENNSYLVANIA AVE STE 127",
            "city": "FORT WASHINGTON",
            "state": "PA",
            "postal_code": "190343409",
            "telephone_number": "215-793-9755",
            "fax_number": "215-412-3587"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1240 S Broad St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Lansdale",
            "state": "PA",
            "postal_code": "194465395",
            "country_code": "US",
            "telephone_number": "215-361-3376",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DETTRA",
        "first_name": "MATTHEW",
        "middle_name": "ROBERT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-13",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neal Brian Demp, MD
• Alexandra Depalma
• Kathryn Deragon
• Dermatology and Cosmetic Surgery Institute, PC
• Meaghan Irene Descher, CRNP, MSN, CCCN
• Colleen Ann Devinney, D.O.
• Amanda Sue Dewall, MSW, BSL
• Cheryl Lisa Doll, PT
• Katherine Dondero, MS
• Pauline J Doyle, MS

• Medical Physician Assistant in Fort Washington, PA
• Providers in Fort Washington, PA by specialty
• Medical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.