Rodrigo Buencamino Mata III, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

33893 Issued in WI

Practice address

6123 Green Bay Rd
Suite 120
Kenosha, WI 53142-2927

Phone

(262) 652-2710

NPI assigned

Jul 1, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vital Signs Wellness LLCGroup PAC ID 4183958978, 4 clinicians

Advantage Physical Therapy and Sports Rehab, LLCGroup PAC ID 8022016336, shared by 3 NPIs, 289 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Accent Care Hospice and Palliative Care of Wi Hospice, West Allis, WI, CCN 521571
• Hospice Alliance Hospice, Pleasant Prairie, WI, CCN 521502
• Froedtert South Inc. Hospital, Kenosha, WI, CCN 520021

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GIFAAA/Endpoint/GIFAAA
• Direct secure messaging: rmata347659@direct.froedtert.com

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.

• Rodrigo B Mata III, M.D., S.C.

  • Internal Medicine Physician
  • Kenosha, WI
  • NPI 1588847099
  Medicare reassignment NPD Authorized official
• Vital Signs Wellness, LLC

  • Family Medicine Physician
  • Schaumburg, IL
  • NPI 1528538600

  WI

  Medicare reassignment Care Compare group NPD
• Accentcare Medical Group of Wisconsin, S.C.

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • West Allis, WI
  • NPI 1275976979
  NPD (past)
• Seasons Hospice & Palliative Care of Wisconsin, LLC

  • Community Based Hospice Care Agency
  • West Allis, WI
  • NPI 1407853112
  NPD (past)

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

• Froedtert South, Inc.

  • General Acute Care Hospital
  • Pleasant Prairie, WI
  • NPI 1003831132
  Care Compare affiliation
• Hospice Alliance, Inc.

  • Community Based Hospice Care Agency
  • Pleasant Prairie, WI
  • NPI 1053314252
  Care Compare affiliation
• Seasons Hospice & Palliative Care of Wisconsin, LLC

  • Community Based Hospice Care Agency
  • West Allis, WI
  • NPI 1407853112
  Care Compare affiliation

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591142400000",
    "number": "1033148176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6123 GREEN BAY RD",
            "address_2": "SUITE 120",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422927",
            "telephone_number": "262-652-2710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6123 GREEN BAY RD",
            "address_2": "SUITE 120",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422927",
            "telephone_number": "262-652-2710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATA",
        "first_name": "RODRIGO",
        "middle_name": "BUENCAMINO",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-01",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "33893",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "508901078009",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21286100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Autumn Marzette-Anderson, LPC
• Molly Mason, CRNA
• Ann Mastrostefano, COTA
• Nicholas Masyga
• Rodrigo A Mata Jr., M.D.
• Heather Nicole Matejka, DMD
• Mathew McCarthy, MD, SC
• Mithin Mathew, DO
• Anitha Mathews, RPH
• Eugene Mathias

• Internal Medicine Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Internal Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2020; 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.