Individual provider Active NPI

Elliot K Mathias, M.D.

  • Family Medicine Physician
  • Shelton, CT
National Provider Identifier
1871669978
Registry record updated May 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20558 Issued in CT
Practice address
110 Commerce Dr
Shelton, CT 06484-6244
Phone
(203) 929-7331
Fax
(203) 925-0330
NPI assigned
Nov 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2019

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 20558 CT Primary

Addresses

Primary practice location

110 Commerce Dr
Shelton, CT 06484-6244

Mailing address

67 Maple Ave
Derby, CT 06418-1328
Phone (203) 732-1330

Other identifiers 1

IdentifierTypeStateIssuer
1205582MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20100901000379 CT Practitioner - Family Practice 0547305336 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Georgetown University School of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Griffin Faculty Physicians IncGroup PAC ID 7618871997, 125 clinicians
Rehabilitation Associates IncGroup PAC ID 8022905322, shared by 2 NPIs, 525 clinicians

Practice addresses (Care Compare)

110 Commerce Dr
Shelton, CT 06484-6244
Phone (203) 929-7331

555 Bridgeport Ave
Shelton, CT 06484-4749
Phone (203) 922-1773

Hospital & facility affiliations

  • Stratford Vna Home health agency, Stratford, CT, CCN 077001
  • Griffin Hospital Hospital, Derby, CT, CCN 070031

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20558CTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Griffin Faculty Physicians, Inc. CurrentSince May 25, 2015 Accepting new patients
The Griffin Hospital PastSince May 25, 2015 Accepting new patients

Locations

130 Division St
Derby, CT 06418
Phone (203) 732-1330

67 Maple Ave
Derby, CT 06418
Phone (203) 732-0699

330 Bridgeport Ave
Shelton, CT 06484
Phone (203) 538-0020

110 Commerce Dr
Shelton, CT 06484
Phone (203) 426-5554

Interoperability endpoints

  • Direct secure messaging: elliot.mathias.1@1323.direct.athenahealth.com

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 2

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": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558051200000",
    "number": "1871669978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 MAPLE AVE",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181328",
            "telephone_number": "203-732-1330",
            "fax_number": "203-732-1332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 COMMERCE DR",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064846244",
            "telephone_number": "203-929-7331",
            "fax_number": "203-925-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIAS",
        "first_name": "ELLIOT",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2019-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "20558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205582",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, CT

Sources for this page

Verify at the official NPI Registry.