Herbert Matanga, CNP

Primary specialty

Child & Adolescent Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0807X

License

11557 Issued in MN

Practice address

19427 136TH Ave N
Rogers, MN 55374-4834

Phone

(763) 516-4476

NPI assigned

May 9, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Yourtime Psychiatry and Medical Cannabis LLCGroup PAC ID 4082077201, 6 clinicians

Integrated Wound Care Minnesota PLLCGroup PAC ID 2769722511, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

Practice roles

Locations

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.

• Integrated Wound Care Minnesota PLLC

  • General Practice Physician
  • Delano, MN
  • NPI 1205390457
  Medicare reassignment Care Compare group NPD
• Yourtime Psychiatry and Medical Cannabis LLC

  • Clinic/Center
  • Maple Grove, MN
  • NPI 1164112090
  Medicare reassignment Care Compare group NPD
• Good State of Mind and Medical Cannabis Psychiatric Clinic

  • Psychiatric/Mental Health Nurse Practitioner
  • Rogers, MN
  • NPI 1790621282
  NPD Authorized official

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

{
    "created_epoch": "1715212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1003664525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19427 136TH AVE N",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553744834",
            "telephone_number": "763-516-4476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19427 136TH AVE N",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553744834",
            "telephone_number": "763-516-4476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATANGA",
        "first_name": "HERBERT",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-09",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0807X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Child & Adolescent",
            "state": "MN",
            "license": "11557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luna Acupuncture LLC
• Luxottica of America Inc
• Mary E. Mahony, D.O.
• Lori Marie Marsherall, P.T.
• Holly Marie Marweg, PHARMD
• Ryan G Meehl
• Larissa Rose Meyer, MT-BC
• Midwest Healthcare Groups PLLC
• Midwest Healthcare Groups PLLC
• Cyrenia Miller

• Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist in Rogers, MN
• Providers in Rogers, MN by specialty
• Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.