NPIMap

Individual provider Active NPI

John R Mathis, M.D.

  • Internal Medicine Physician
  • Anacortes, WA
National Provider Identifier
1780754739
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD00031284 Issued in WA
Practice address
1213 24TH St
#100
Anacortes, WA 98221-2592
Phone
(360) 293-1115
NPI assigned
Nov 8, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD00031284 WA Primary

Addresses

Primary practice location

1213 24TH St
#100
Anacortes, WA 98221-2592

Mailing address

1213 24TH St
#100
Anacortes, WA 98221-2592
Phone (360) 293-1115

Other identifiers 1

IdentifierTypeStateIssuer
1088947MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090324000021 WA Practitioner - Internal Medicine 3072670884 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Utah School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

1211 24TH St
Anacortes, WA 98221-2562
Phone (360) 299-1350

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00031284WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital District No 2 Skagit County Washington CurrentSince May 1, 2015 Accepting new patients
Public Hospital District No 2 Skagit County Washington CurrentSince May 1, 2015 Accepting new patients
Public Hospital District No 2 Skagit County Washington Current Accepting new patients
Northwest Hospital Medicine Physicians LLC Internal Medicine CurrentSince Apr 1, 2020 Accepting new patients
Public Hospital District No 2 Skagit County Washington Past Accepting new patients

Locations

1211 24th St
Anacortes, WA 98221
Phone (360) 293-3181

1213 24th St
Ste 100
Anacortes, WA 98221
Phone (360) 293-3101

Organizations & group practices 6

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780754739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1213 24TH ST",
            "address_2": "#100",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982212592",
            "telephone_number": "360-293-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 24TH ST",
            "address_2": "#100",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982212592",
            "telephone_number": "360-293-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "JOHN",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00031284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1088947",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anacortes, WA

Sources for this page

Verify at the official NPI Registry.