Mandy Warner Matta, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA60977434 Issued in WA

Practice address

904 7TH Ave
Seattle, WA 98104-1132

Phone

(206) 329-1760

NPI assigned

Jul 29, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

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

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwest Radiologists Inc PSGroup PAC ID 1456248368, 27 clinicians

Mt Baker Imaging LLCGroup PAC ID 7113963802, 34 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peacehealth St Joseph Medical Center Hospital, Bellingham, WA, CCN 500030

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Mt Baker Imaging LLC

  • Diagnostic Radiology Physician
  • Bellingham, WA
  • NPI 1295725133
  Medicare reassignment Care Compare group
• Northwest Radiologists Inc PS

  • Diagnostic Radiology Physician
  • Bellingham, WA
  • NPI 1013907955
  Medicare reassignment Care Compare group
• The Polyclinic PLLC

  • Audiologist
  • Seattle, WA
  • NPI 1174594634
  Medicare reassignment NPD
• Proliance Surgeons Inc P S

  • Orthopaedic Surgery Physician
  • Seattle, WA
  • NPI 1023170313
  Medicare reassignment
• Proliance Surgeons Inc P S

  • Orthopaedic Hand Surgery Physician
  • Kirkland, WA
  • NPI 1134165897
  NPD
• Proliance Surgeons Inc P S

  • Orthopaedic Surgery Physician
  • Renton, WA
  • NPI 1235091463

  Surgical

  NPD
• The Polyclinic PLLC

  • Durable Medical Equipment & Medical Supplies
  • Tacoma, WA
  • NPI 1831411487
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Peacehealth

  • Rural Acute Care Hospital
  • Bellingham, WA
  • NPI 1487904546
  Care Compare affiliation
• Peacehealth

  • General Acute Care Hospital
  • Bellingham, WA
  • NPI 1689677320
  Care Compare affiliation
• St Joseph Hospital

  • Clinical Medical Laboratory
  • Bellingham, WA
  • NPI 1013137173

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1564358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658880000000",
    "number": "1013561943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 7TH AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041132",
            "telephone_number": "206-329-1760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 7TH AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041132",
            "telephone_number": "206-329-1760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 Broadway Fl 6",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981225330",
            "country_code": "US",
            "telephone_number": "206-386-2600",
            "fax_number": "206-622-1644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "751 NE Blakely Dr Ste 4020",
            "address_purpose": "LOCATION",
            "city": "Issaquah",
            "state": "WA",
            "postal_code": "980296201",
            "country_code": "US",
            "telephone_number": "206-386-2600",
            "fax_number": "206-622-1644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTA",
        "first_name": "MANDY",
        "middle_name": "WARNER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-29",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA60977434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.polyclinic.com/locations-nav/providers/wa/mandy-warner-pac/1013561943.html",
            "affiliation": "N",
            "endpointDescription": "Webiste Bio",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "URL",
            "address_1": "904 7th Ave",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981041132",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stephanie Akemi Matsuura, MD
• Edward K Matsuwaka, RPH
• Sean Matsuwaka, MD
• Matt Brown-Ruegg DC PS
• Matt Meyers Therapy PLLC
• Aleta Annamarie Mattaino, M.A., L.M.H.C., N.C.
• Eduardo Mattar
• Cidney Shanae Mattausch, PHARMD
• Katherine Elizabeth Gaston Mattax, ND
• Brenda Jean Matter, PHYSICAL THERAPIST

• Surgical Physician Assistant in Seattle, WA
• Providers in Seattle, WA by specialty
• Surgical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; 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.