MATTHEW ROBERT DETTRA (PA-C) – Medical Physician Assistant, NPI 1760041636

MATTHEW ROBERT DETTRA (PA-C) is a healthcare provider. based in Southampton, Pennsylvania. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA-C. The NPI Number for MATTHEW ROBERT DETTRA (PA-C) is 1760041636

Main info

Male
7 Years Of Experience
Accepts Medicare Assignment
Name
MATTHEW ROBERT DETTRA (PA-C)
NPI
1760041636
Phone
Not provided
Address
484 SILVER AVE
Enumeration Date
13 June 2019
Last Update Date
25 May 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2157939755
Graduation Year
2019 (7 years ago)
PAC ID
8022444280
Group Practice PAC ID
2466519343
Professional Enrollment ID
I20200206000919
Address ID
PA190343409FO455XXAVEX301
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience29
Completeness75
Years active:7State licenses:0Digital endpointsOther names

9,738 PHYSICIAN ASSISTANT in PA

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Provider Addresses for MATTHEW ROBERT DETTRA (PA-C)

  • 484, Silver Avenue, Upper Southampton Township, Bucks County, Pennsylvania, 18966, United States

    SOUTHAMPTON, PA 189663541

    Phone:

    Type: Mailing

  • 822, Pine Street, Bella Vista, Philadelphia, Philadelphia County, Pennsylvania, 19107, United States

    PHILADELPHIA, PA 191076187

    Phone: (267) 519-0154

    Type: Location

  • 1240 S Broad St Ste 200

    Lansdale, PA 194465395

    Phone: (215) 361-3376

    Type: Location

  • 455 PENNSYLVANIA AVE STE 127

    FORT WASHINGTON, PA 190343409

    Phone: (215) 793-9755

    Fax: (215) 412-3587

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 208 Open Payments records for all available years, with a total value of $4,676.

Total Amount is formed as General ($4,676) + Research ($0) + Ownership ($0) = $4,676.

Last reported payment date: 2024-12-23 • Largest payer in this snapshot: Janssen Biotech, Inc. ($1,259).

Total Amount

$4,676

General + Research + Ownership

Payments

208

Total payment records

General Amount

$4,676

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-23

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2020-02-06

PECOS data refreshed: 2026-06-15

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20200206000919IPhysician AssistantPATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
17003Destruction of precancer skin growth, 2-14 growths10622$0
99213Established patient office or other outpatient visit, 20-29 minutes7772$0
11102Biopsy of related skin growth, first growth4240$0
17000Destruction of precancer skin growth, 1 growth3633$0
17110Destruction of skin growth, 1-14 growths1913$0
View full utilization report →

Insurance plans in this area (ZIP 18966)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2466519343View full group profile
NameSpecialtyState
Physician AssistantPA
Dermatology, Micrographic Dermatologic Surgery (Mds)PA
Dermatology, Micrographic Dermatologic Surgery (Mds)PA
D E R M A T O L O G YPA

Reviews

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Frequently asked questions

Can I cross-check MATTHEW ROBERT DETTRA (PA-C) using NPI 1760041636?
NPI 1760041636 belongs to MATTHEW ROBERT DETTRA (PA-C); compare other details if you need extra assurance.
Is MATTHEW ROBERT DETTRA (PA-C) shown as active in public data?
Registry records indicate MATTHEW ROBERT DETTRA (PA-C) maintains an active NPI.
How would a patient describe MATTHEW ROBERT DETTRA (PA-C)'s focus?
For MATTHEW ROBERT DETTRA (PA-C), the primary taxonomy reads as Medical Physician Assistant. Clinical services aligned with this taxonomy classification.
What locale is associated with MATTHEW ROBERT DETTRA (PA-C)?
Directory geography for MATTHEW ROBERT DETTRA (PA-C) centers on Southampton, Pennsylvania.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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