Active NPI
Frank R Mattia, MD
- Pediatrics Physician
- Green Bay, WI
National Provider Identifier
1053460352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 32595-20
- Practice address
- 2845 Greenbrier Rd
4TH FL
Green Bay, WI 54311-6519 - Phone
- (920) 288-8400
- NPI assigned
- Jan 9, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 32595 | WI | |
| Pediatrics Physician | 208000000X | 32595-20 | WI | Primary |
Addresses
Primary practice location
2845 Greenbrier Rd
4TH FL
Green Bay, WI 54311-6519
Mailing address
2845 Greenbrier Rd
4TH FL
Green Bay, WI 54311-6519
Phone (920) 288-8400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32438200 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32595 | WI | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302652800000",
"number": "1053460352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2845 GREENBRIER RD",
"address_2": "4TH FL",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543116519",
"telephone_number": "920-288-8400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2845 GREENBRIER RD",
"address_2": "4TH FL",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543116519",
"telephone_number": "920-288-8400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTIA",
"first_name": "FRANK",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2011-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WI",
"license": "32595",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WI",
"license": "32595-20",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32438200",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.