Mario Mata

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

AP60886621 Issued in WA

Practice address

10200 NE 132ND St
Kirkland, WA 98034-2831

Phone

(425) 821-2000

NPI assigned

May 10, 2022

Last updated

May 10, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rejuvenation Medical PLLCGroup PAC ID 4880083062, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wesley Homes at Home, LLC Home health agency, Des Moines, WA, CCN 507092
• Caroline Kline Galland Home Nursing home, Seattle, WA, CCN 505442

Medicare enrollment (NPD)

Enrolled

Credentials

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rejuvenation Medical PLLC

  • Family Medicine Physician
  • Edgewood, WA
  • NPI 1447712559
  Medicare reassignment Care Compare group NPD

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

• Caroline Kline Galland Home

  • Skilled Nursing Facility
  • Seattle, WA
  • NPI 1407863475

  Nursing home

  Care Compare affiliation
• Wesley Homes at Home, LLC

  • Home Health Agency
  • Seattle, WA
  • NPI 1740312479
  Care Compare affiliation

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

{
    "created_epoch": "1652140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1053057117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19435 68TH AVE S STE S101",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980322114",
            "telephone_number": "206-407-4171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10200 NE 132ND ST",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980342831",
            "telephone_number": "425-821-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATA",
        "first_name": "MARIO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-10",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WA",
            "license": "AP60886621",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WA",
            "license": "AP60886621",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald E Mason, MD
• Sara Masoum, RN
• Massa Wellness LLC
• Timothy Hayes Massey, M.D.
• Donald K Masters, LDO
• Jennifer Michele Matin, PHARMD
• Martin Matney, ATC, PTA
• Russell W Matney
• Kei Matsumoto
• Kyle Jiro Matsumoto, OT

• Adult Health Nurse Practitioner in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Adult Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 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.