Individual provider Active NPI

Matthew R Pittman, M.D.

  • Surgery Physician
  • Columbus, OH
National Provider Identifier
1861621633
Registry record updated Sep 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036138487 Issued in IL
Practice address
4830 Knightsbridge Blvd
Suite J
Columbus, OH 43214-2300
Phone
(614) 293-3230
Fax
(614) 293-4030
NPI assigned
Jul 14, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 125.055834 IL
Surgery Physician 208600000X 35123279 OH
Surgery Physician 208600000X 036138487 IL Primary

Addresses

Primary practice location

4830 Knightsbridge Blvd
Suite J
Columbus, OH 43214-2300

Mailing address

351 Delnor Dr
Geneva, IL 60134-4222
Phone (630) 668-0833

Other identifiers 3

IdentifierTypeStateIssuer
0104249MedicaidOK
206147OtherILMEDICARE PTAN GROUP
F400237729OtherILMEDICARE PTAN INDIVIDUAL

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150828000938 IL Practitioner - General Surgery 2264657659 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Georgetown University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

1800 N Main St
Wheaton, IL 60187-3112
Phone (630) 933-4800

25 N Winfield Rd
Winfield, IL 60190-1295

300 Randall Rd
Geneva, IL 60134-4200
Phone (630) 933-4700

304 Randall Rd
Geneva, IL 60134-4200
Phone (630) 307-7799

Hospital & facility affiliations

  • Northwestern Medicine Delnor Community Hospital Hospital, Geneva, IL, CCN 140211
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Northwestern Medicine Kishwaukee Hospital Hospital, Dekalb, IL, CCN 140286

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux13
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036138487ILMDSurgery Physician
125.055834ILMDSurgery Physician
35123279OHMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Aug 19, 2015 Accepting new patients
Central Dupage Physician Group CurrentSince Aug 19, 2015 Accepting new patients

Locations

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

300 Randall Rd
Ste 100
Geneva, IL 60134
Phone (630) 933-3513

351 Delnor Dr
Ste 400
Geneva, IL 60134
Phone (630) 232-2885

351 Delnor Dr
Geneva, IL 60134
Phone (630) 262-1001

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

25 N Winfield Rd
#410
Winfield, IL 60190
Phone (630) 293-4326

25 N Winfield Rd
Winfield, IL 60190
Phone (630) 682-1600

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1247529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442448000000",
    "number": "1861621633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 DELNOR DR",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601344222",
            "telephone_number": "630-668-0833",
            "fax_number": "630-667-7685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4830 KNIGHTSBRIDGE BLVD",
            "address_2": "SUITE J",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432142300",
            "telephone_number": "614-293-3230",
            "fax_number": "614-293-4030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PITTMAN",
        "first_name": "MATTHEW",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-14",
        "last_updated": "2015-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "125.055834",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35123279",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036138487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0104249",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN GROUP",
            "identifier": "206147",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN INDIVIDUAL",
            "identifier": "F400237729",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.