Individual provider Active NPI

Matthew Samuel Gambino, O.D.

  • Optometrist
  • Pennsville, NJ
National Provider Identifier
1962062430
Registry record updated Jun 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
27OA00693100 Issued in NJ
Practice address
48 N Broadway Ste a
Pennsville, NJ 08070-1754
Phone
(856) 678-4800
Fax
(856) 678-3630
NPI assigned
Jun 17, 2019
Last updated
Jun 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 16, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 27OA00693100 NJ Primary
Optometrist 152W00000X OEG003556 PA

Addresses

Primary practice location

48 N Broadway Ste a
Pennsville, NJ 08070-1754

Mailing address

48 N Broadway Ste a
Pennsville, NJ 08070-1754
Phone (856) 678-4800

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200226000363 NJ Practitioner - Optometry 5193152445 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mazzuca Eye and Laser Centers,PAGroup PAC ID 5698775906, 4 clinicians

Practice addresses (Care Compare)

48 N Broadway
Pennsville, NJ 08070-1756
Phone (856) 678-4800

Merit-based Incentive Payment System (MIPS)

Final score
92.17 of 100Reported as group
Quality
89.37
Promoting interoperability
96
Improvement activities
40
Cost
87.88

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
27OA00693100NJMDOptometrist
OEG003556PAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Mazzuca Eye and Laser Centers,PA CurrentSince Jun 1, 2021 Accepting new patients

Locations

48 N Broadway
Pennsville, NJ 08070
Phone (856) 678-4800

48 N Broadway
Ste A
Pennsville, NJ 08070
Phone (856) 678-4800

20 Village Center Dr
Swedesboro, NJ 08085
Phone (610) 690-4900

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1962062430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 N BROADWAY STE A",
            "city": "PENNSVILLE",
            "state": "NJ",
            "postal_code": "080701754",
            "telephone_number": "856-678-4800",
            "fax_number": "856-678-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 N BROADWAY STE A",
            "city": "PENNSVILLE",
            "state": "NJ",
            "postal_code": "080701754",
            "telephone_number": "856-678-4800",
            "fax_number": "856-678-3630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBINO",
        "first_name": "MATTHEW",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-17",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00693100",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG003556",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pennsville, NJ

Sources for this page

Verify at the official NPI Registry.