Provider Demographics
NPI:1801875257
Name:MATTHIAS, MONICA SARAH (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:SARAH
Last Name:MATTHIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 NORTHWOODS DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-3092
Mailing Address - Country:US
Mailing Address - Phone:402-465-5600
Mailing Address - Fax:402-327-6074
Practice Address - Street 1:3262 SALT CREEK CIR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-4761
Practice Address - Country:US
Practice Address - Phone:402-465-5600
Practice Address - Fax:402-327-6074
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24830208000000X
IA35685208000000X
IL036111995208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL336072938OtherCONTROLLED SUBSTANCE #
IA0568998Medicaid
IL036111995Medicaid
IL097656OtherHEALTH ALLIANCE
IL94652OtherIOWA BC/BS SEEN IN MOLINE
ILBM8298639OtherFEDERAL DEA #
IA421060724OtherBILLING TAX ID# FOR CHC
IL421060724A9OtherJOHN DEERE HEALTH
IL8122859OtherILLINOIS BC/BS
IL245772OtherMIDLAND'S CHOICE
IL421060724003Medicaid
IL9532514OtherMULTIPLAN
ILIL0A9OtherJOHN DEERE EDI#
IA0568980Medicaid
NE47079049100Medicaid
ILI12984Medicare UPIN
IAI12658Medicare ID - Type UnspecifiedMEDICARE PART B IA
ILK09892Medicare ID - Type UnspecifiedMEDICARE PART B IL
IA0568980Medicaid