Active NPI
Matt Mazzino, RD, LD
- Registered Dietitian
- Cleveland, OH
National Provider Identifier
1043035728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD.08244
- Practice address
- 11603 Fidelity Ave
Cleveland, OH 44111-3651 - Phone
- (440) 567-8008
- NPI assigned
- Nov 18, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | LD.08244 | OH | Primary |
Addresses
Primary practice location
11603 Fidelity Ave
Cleveland, OH 44111-3651
Mailing address
11603 Fidelity Ave
Cleveland, OH 44111-3651
Phone (440) 567-8008
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250102002615 | OH | Practitioner - Registered Dietitian Or Nutrition Professional | 7719414762 |
Care Compare profile
Medicare Care Compare- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 2017
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
212 Tallowwood Dr
Westerville, OH 43081-4547
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
| Fig Health, Inc | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1731888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734393600000",
"number": "1043035728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11603 FIDELITY AVE",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441113651",
"telephone_number": "440-567-8008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11603 FIDELITY AVE",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441113651",
"telephone_number": "440-567-8008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZZINO",
"first_name": "MATT",
"credential": "RD, LD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-11-18",
"last_updated": "2024-12-17",
"certification_date": "2024-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OH",
"license": "LD.08244",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.