Shelley Boehm Mattia, M.D.
Individual provider Active NPI Psychiatry Physician · Waunakee, WI
NPI 1073662938 · NPPES record last updated Nov 29, 2023
Key facts
- NPI
- 1073662938
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 39641 (WI)
- Practice address
- 4845 Morris CT
Waunakee, WI 53597-9164 - Phone
- (920) 965-6768
- Fax
- (920) 965-6769
- NPI assigned
- Jan 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- University of Wisconsin School of Medicine, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
4845 Morris CT
Waunakee, WI 53597-9164
Phone (920) 965-6768
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100803000689 | WI | Practitioner - Psychiatry | 9335272913 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39641 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shelley Boehm Mattia MD,Adult Psychiatry, LLC | Adult Mental Health | Current |
Accepting new patients |
Locations
215 S Century Ave
Waunakee, WI 53597
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 39641 | WI | Yes |
| Adult Mental Health Clinic/Center | 261QM0850X |
Addresses
Primary practice location
4845 Morris CT
Waunakee, WI 53597-9164
Mailing address
215 S Century Ave Ste 128
Waunakee, WI 53597-1249
Phone (920) 965-6768
Other providers in Waunakee, WI
- Amanda Jean Beckman
- Kate Beggs
- Deanna Beatrice Bennett
- Michael Bergemann
- Miryam Bernard-Donals
- Melissa Mary Carole Bowe
- Lynn M Braun
- Taylor Leigh Brown
- Curtis W Bush
- Lilian Busse
All providers in Waunakee, WI · Psychiatry Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.