NPIMap

Individual provider Active NPI

Shiva A Mathura, MD

  • Family Medicine Physician
  • Debary, FL
National Provider Identifier
1912247719
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME114515 Issued in FL
Practice address
110 Pond CT Ste 203
Debary, FL 32713-2717
Phone
(386) 259-4106
Fax
(866) 554-1654
NPI assigned
Feb 15, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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 ME114515 FL Primary

Addresses

Primary practice location

110 Pond CT Ste 203
Debary, FL 32713-2717

Mailing address

110 Pond CT Ste 203
Debary, FL 32713-2717
Phone (386) 259-4106

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL eClinicalworks

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20130903000022 FL Practitioner - Family Practice 0648413120 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

110 Pond CT
Suite 203
Debary, FL 32713-2717
Phone (386) 259-4106

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mathura Medical Group Inc Family Medicine CurrentSince Jun 1, 2021 Accepting new patients
Southwest Volusia Healthcare Corporation Past Accepting new patients

Locations

110 Pond Ct
Ste 203
Debary, FL 32713
Phone (386) 259-4106

255 Primera Blvd
Ste 160
Lake Mary, FL 32746
Phone (407) 585-0825

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DDBFCD/Endpoint/DDBFCD

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 8

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": "1360886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1912247719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 POND CT STE 203",
            "city": "DEBARY",
            "state": "FL",
            "postal_code": "327132717",
            "telephone_number": "386-259-4106",
            "fax_number": "866-554-1654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 POND CT STE 203",
            "city": "DEBARY",
            "state": "FL",
            "postal_code": "327132717",
            "telephone_number": "386-259-4106",
            "fax_number": "866-554-1654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHURA",
        "first_name": "SHIVA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-02-15",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME114515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "eClinicalworks",
            "affiliation": "N",
            "address_1": "110 Pond Ct Ste 203",
            "city": "Debary",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327132717",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Debary, FL

Sources for this page

Verify at the official NPI Registry.