Active NPI
Matthieu Philippe Declerck, M.D.
- Personal Emergency Response Attendant
- Stanford, CA
National Provider Identifier
1891975538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Personal Emergency Response Attendant
- License
- A101627
- Practice address
- 300 Pasteur Dr
Alway Building, Room 121
Stanford, CA 94305-2200 - Phone
- (650) 725-9445
- NPI assigned
- Nov 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Personal Emergency Response Attendant | 146D00000X | A101627 | CA | Primary |
| Emergency Medicine Physician | 207P00000X | 48842 | CO |
Addresses
Primary practice location
300 Pasteur Dr
Alway Building, Room 121
Stanford, CA 94305-2200
Mailing address
203 Annandale Rd
Pasadena, CA 91105-1407
Phone (323) 828-8482
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 68132735 | Medicaid | CO | |
| 021043 | Other | CO | KAISER COMMERCIAL NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| LPCH Medical Group Div of Lucile | Past | Accepting new patients | |
| Stanford Health Care | Emergency Medicine | Past | Accepting new patients |
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.
-
- Children's Hospital
- Palo Alto, CA
- NPI 1417907940
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378166400000",
"number": "1891975538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 ANNANDALE RD",
"city": "PASADENA",
"state": "CA",
"postal_code": "911051407",
"telephone_number": "323-828-8482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 PASTEUR DR",
"address_2": "ALWAY BUILDING, ROOM 121",
"city": "STANFORD",
"state": "CA",
"postal_code": "943052200",
"telephone_number": "650-725-9445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DECLERCK",
"first_name": "MATTHIEU",
"middle_name": "PHILIPPE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-11-09",
"last_updated": "2013-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "146D00000X",
"taxonomy_group": "",
"desc": "Personal Emergency Response Attendant",
"state": "CA",
"license": "A101627",
"primary": true
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "CO",
"license": "48842",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "68132735",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER COMMERCIAL NUMBER",
"identifier": "021043",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stanford, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.