Jacob Mathew Jr., D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

DOS-1566 Issued in HI

Practice address

1650 Cochrane Cir
Evans Army Community Hospital
Fort Carson, CO 80913-4613

Phone

(719) 526-6073

NPI assigned

Jun 17, 2012

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 CO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• X Awaiting Inactivation3

  • Military Hospital
  • Fort Rucker, AL
  • NPI 1174774863
  NPD

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

{
    "created_epoch": "1339891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441152000000",
    "number": "1992068894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 COCHRANE CIR",
            "address_2": "EVANS ARMY COMMUNITY HOSPITAL",
            "city": "FORT CARSON",
            "state": "CO",
            "postal_code": "809134613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COCHRANE CIR",
            "address_2": "EVANS ARMY COMMUNITY HOSPITAL",
            "city": "FORT CARSON",
            "state": "CO",
            "postal_code": "809134613",
            "telephone_number": "719-526-6073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-17",
        "last_updated": "2015-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "HI",
            "license": "DOS-1566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "VAD000",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Rene Martinez
• Joseph Martinson, CPTA
• Lindsey Shay Masdeu, PA-C
• Victoria S Masih, LCSW
• Mariama Amina Massaquoi, M.D.
• Daniel Matthes
• Matthew Morrison Mayfield, M.D.
• Mitchell Mayfield, PA-C
• Jaclyn Mazza, OTR/L
• Erica Mazzaferri

• Internal Medicine Physician in Fort Carson, CO
• Providers in Fort Carson, CO by specialty
• Internal Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2015; 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.