Individual provider Active NPI

Vaughn Mitchell Matacale, M.D.

  • Specialist
  • Wilson, NC
National Provider Identifier
1063471084
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Practice address
1705 Tarboro St SW
Wilson, NC 27893-3428
Phone
(252) 399-8040
Fax
(252) 399-8829
NPI assigned
Mar 20, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NC Primary

Addresses

Primary practice location

1705 Tarboro St SW
Wilson, NC 27893-3428

Mailing address

1705 Tarboro St SW
Wilson, NC 27893-3428
Phone (252) 399-8040

Other identifiers 1

IdentifierTypeStateIssuer
89135JXMedicaidNC

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20041214000769 NC Practitioner - Internal Medicine 6103883871 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2003-00658NCMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Vidant Medical Group LLC CurrentSince Oct 15, 2007 Accepting new patients
Wilson Medical Center, Inc. Past Accepting new patients

Locations

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

240 Smith Church Rd
Ste A
Roanoke Rapids, NC 27870
Phone (252) 399-7055

1705 Tarboro St SW
Wilson, NC 27893
Phone (252) 399-8040

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

NPI Registry JSON

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1063471084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 TARBORO ST SW",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278933428",
            "telephone_number": "252-399-8040",
            "fax_number": "252-399-8829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 TARBORO ST SW",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278933428",
            "telephone_number": "252-399-8040",
            "fax_number": "252-399-8829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATACALE",
        "first_name": "VAUGHN",
        "middle_name": "MITCHELL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-20",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89135JX",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilson, NC

Sources for this page

Verify at the official NPI Registry.