Individual provider Active NPI

Tara Anne Matthews, M.D.

  • Pediatrics Physician
  • Mountainside, NJ
National Provider Identifier
1942226287
Registry record updated Jul 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
25MA07594100 Issued in NJ
Practice address
150 New Providence Rd
Children's Specialized Hospital
Mountainside, NJ 07092-2590
Phone
(908) 301-5491
Fax
(908) 301-5408
NPI assigned
Jul 13, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 3, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 25MA07594100 NJ Primary

Addresses

Primary practice location

150 New Providence Rd
Children's Specialized Hospital
Mountainside, NJ 07092-2590

Mailing address

815 Mountain Ave Apt C19
Springfield, NJ 07081-3446
Phone (973) 467-0625

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20160629002757 NJ Practitioner - Pediatric Medicine 0749572345 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA07594100NJMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Specialized Hospital Pediatrics CurrentSince Jun 6, 2016 Accepting new patients
Children' Specialized Hospital CurrentSince Jun 6, 2016 Accepting new patients
Saint Barnabas Multi Specialty Pediatrics Past Accepting new patients

Locations

150 New Providence Rd
Mountainside, NJ 07092

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404345600000",
    "number": "1942226287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 MOUNTAIN AVE APT C19",
            "city": "SPRINGFIELD",
            "state": "NJ",
            "postal_code": "070813446",
            "telephone_number": "973-467-0625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 NEW PROVIDENCE RD",
            "address_2": "CHILDREN'S SPECIALIZED HOSPITAL",
            "city": "MOUNTAINSIDE",
            "state": "NJ",
            "postal_code": "070922590",
            "telephone_number": "908-301-5491",
            "fax_number": "908-301-5408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTHEWS",
        "first_name": "TARA",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-13",
        "last_updated": "2014-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA07594100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountainside, NJ

Sources for this page

Verify at the official NPI Registry.