Organization Active NPI

Jared Mataska MD PA

  • Family Medicine Physician
  • Graham, TX
National Provider Identifier
1043774896
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
JARED MATASKA MD PA
Practice address
1339 East St
Graham, TX 76450-4228
Phone
(940) 521-5500
NPI assigned
Jan 25, 2019
Last updated
Mar 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

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

Authorized official

Name
Jared Mataska, MDNPI 1780033753
Title
Managing Owner
Phone
(940) 521-5500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1339 East St
Graham, TX 76450-4228

Mailing address

1339 East St
Graham, TX 76450-4228
Phone (940) 521-5500

Other identifiers 1

IdentifierTypeStateIssuer
R4429OtherTXTMB LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190503001244 TX Part B Supplier - Clinic/Group Practice 2567704992 Receives reassigned benefits from 1 practitioner
Practice locations: Graham, TX

National Provider Directory

National Provider Directory

Locations

808 Brook Ave
Wichita Falls, TX 76301
Phone (940) 696-7578

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1548374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614729600000",
    "number": "1043774896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1339 EAST ST",
            "city": "GRAHAM",
            "state": "TX",
            "postal_code": "764504228",
            "telephone_number": "940-521-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1339 EAST ST",
            "city": "GRAHAM",
            "state": "TX",
            "postal_code": "764504228",
            "telephone_number": "940-521-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JARED MATASKA MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-25",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A",
        "authorized_official_last_name": "MATASKA",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "MANAGING OWNER",
        "authorized_official_telephone_number": "940-521-5500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TMB LICENSE",
            "identifier": "R4429",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Graham, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.