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MATTHEW ROBERT DETTRA PA-C
NPI 1760041636
Physician Assistant - Medical in Fort Washington, PA

Active since June 13, 2019PECOS EnrolledAccepts Medicare Assignment
77.05/100
CMS Quality Rating
455 PENNSYLVANIA AVE STE 127, FORT WASHINGTON, PA 19034(215) 793-9755(215) 412-3587 Get Directions Write a Review

NPPES record last updated: May 25, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 25, 2023, Feb 7, 2023, Jun 13, 2019 (3 updates tracked since 2019).

About Matthew Robert Dettra Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MATTHEW ROBERT DETTRA PA-C (NPI 1760041636) is an individual medical provider in Fort Washington, Pennsylvania and active in the NPI registry since June 2019. He is enrolled in Medicare PECOS, maintains a secondary practice location in Lansdale, and is a graduate of Other (2019).

NPPES Registry Identity

NPI1760041636
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameMATTHEW ROBERT DETTRACredential: PA-C
Location Address455 PENNSYLVANIA AVE STE 127Fort Washington, PA 19034-3409
Mailing Address455 Pennsylvania Ave Ste 127Fort Washington, PA 19034-3409 · (215) 793-9755
Phone(215) 793-9755
Fax(215) 412-3587
Sole ProprietorNo
Medical School CMSOtherGraduated 2019
Enumeration DateJune 13, 2019
Last NPPES UpdateMay 25, 20233 updates tracked since enumeration
NPPES CertifiedMay 24, 2023
✔ NPI 1760041636 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
455 PENNSYLVANIA AVE STE 127, Fort Washington, PA 19034
Open in Google Maps ↗

Secondary Practice Location 1

Location 11240 S Broad St Ste 200Lansdale, PA 19446-5395 · Phone (215) 361-3376

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Matthew Robert Dettra Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8022444280
PECOS Enrollment IDI20200206000919
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

77.05/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Promoting Interoperability73
Improvement Activities40

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHAEL PETER FRANK M.D.
Dermatology (MOHS-Micrographic Surgery)
455 PENNSYLVANIA AVE STE 127
FORT WASHINGTON, PA 19034
Montgomery County (215) 793-9755

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Matthew Dettra's NPI number?

The NPI number for Matthew Dettra is 1760041636. It was assigned to this individual provider in the NPPES registry on June 13, 2019.

Where is Matthew Dettra located?

Matthew Dettra practices at 455 Pennsylvania Ave Ste 127, Fort Washington, PA 19034. The listed phone number is (215) 793-9755.

What is Matthew Dettra's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Matthew Dettra enrolled in Medicare?

Yes. Matthew Dettra is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Matthew Dettra was last updated on May 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.