Matthew J Derosby, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA534 Issued in ME

Practice address

234 State St
Brewer, ME 04412-1519

Phone

(207) 989-0550

Fax

(207) 989-0551

NPI assigned

Apr 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Convenientmd - FFS UC LLC

  • Urgent Care Clinic/Center
  • Ellsworth, ME
  • NPI 1780375220
  Medicare reassignment
• Rehabilitation Associates PC

  • Physical Medicine & Rehabilitation Physician
  • Portland, ME
  • NPI 1629430087
  Medicare reassignment
• Convenientmd - FFS UC LLC

  • Urgent Care Clinic/Center
  • Farmington, ME
  • NPI 1346130713
  NPD
• Convenientmd - FFS UC LLC

  • Urgent Care Clinic/Center
  • Sturbridge, MA
  • NPI 1386526192
  NPD
• Convenientmd - FFS UC LLC

  • Urgent Care Clinic/Center
  • Bangor, ME
  • NPI 1336830868
  NPD (past)

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700006400000",
    "number": "1942266150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 WHITING HILL RD STE 300",
            "city": "BREWER",
            "state": "ME",
            "postal_code": "044121006",
            "telephone_number": "207-989-0550",
            "fax_number": "207-989-0551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 STATE ST",
            "city": "BREWER",
            "state": "ME",
            "postal_code": "044121519",
            "telephone_number": "207-989-0550",
            "fax_number": "207-989-0551"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "543 Broadway",
            "address_purpose": "LOCATION",
            "city": "Bangor",
            "state": "ME",
            "postal_code": "044013337",
            "country_code": "US",
            "telephone_number": "207-922-1300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEROSBY",
        "first_name": "MATTHEW",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-25",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "ME",
            "license": "PA534",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ME",
            "license": "PA534",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205060099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grace Davis, PHARMD
• Anthony Joseph Decosta, PHARMD
• Kathleen Fay Dehaven, LCSW
• Jenna Rae Demers, PT, DPT
• Megan Derba, PHARM.D.
• Catherine A Derosier, LCPC
• Hilary Devine
• Collette Therese Dibello, CF-SLP
• Kathryn E Dobrovolny, PAC
• Judith Dolinar, OTA

• Medical Physician Assistant in Brewer, ME
• Providers in Brewer, ME by specialty
• Medical Physician Assistant in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.