NPIMap

Individual provider Active NPI

Angela Feazel Mattke, MD

  • Emergency Medical Services (Emergency Medicine) Physician
  • Conyers, GA
National Provider Identifier
1083672786
Registry record updated May 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
057540 Issued in GA
Practice address
1412 Milstead Ave NE
Conyers, GA 30012-3877
Phone
(770) 994-9326
Fax
(770) 994-4747
NPI assigned
May 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 35.123208 OH
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 057540 GA Primary

Addresses

Primary practice location

1412 Milstead Ave NE
Conyers, GA 30012-3877

Mailing address

1745 Phoenix Blvd
Suite 100
Atlanta, GA 30349-5591
Phone (770) 994-9326

Other practice location 1

410 W 10th Ave
Columbus, OH 43210-1240
Phone (614) 293-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, KY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140520002060 OH Practitioner - Emergency Medicine 9234141656 Reassigns benefits to 3 organizations
I20241030000794 KY Practitioner - Emergency Medicine 9234141656 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.123208OHMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Physicians of Estill County,PLLC Emergency Medicine CurrentSince Sep 19, 2024 Accepting new patients
Highland District Hospital CurrentSince Jul 17, 2020 Accepting new patients
Highland District Hospital Current Accepting new patients
Emergency Medicine Physicians of Champaign County LTD Emergency Medicine CurrentSince Aug 30, 2023 Accepting new patients
Parkway Anesthesia Consultants, PC Past Accepting new patients
Emerginet, LLC Emergency Medical Services PastSince Jul 1, 2001 Accepting new patients
Summit Macon LLC Emergency Medical Services Past Accepting new patients
Cherokee Emergency Services, LLC Emergency Medical Services Past Accepting new patients
Emergency Medicine Physicians of Fayette County LTD Emergency Medicine Past Accepting new patients
Emergency Medicine Physicians of Lawrence County LTD Emergency Medicine Past Accepting new patients
Emergency Medicine Physicians of York County, LTD Emergency Medicine Past Accepting new patients

Locations

60 Mercy Ct
Irvine, KY 40336
Phone (606) 723-2115

3300 Mercy Health Blvd
Cincinnati, OH 45211
Phone (513) 215-1114

1275 N High St
Hillsboro, OH 45133
Phone (937) 393-5503

100 Medical Center Dr
Springfield, OH 45504
Phone (937) 523-1000

Interoperability endpoints

  • FHIR API: https://epicscripts.trihealth.com/fhirproxy/api/FHIR/R4/

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653350400000",
    "number": "1083672786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1745 PHOENIX BLVD",
            "address_2": "SUITE 100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303495591",
            "telephone_number": "770-994-9326",
            "fax_number": "770-994-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 MILSTEAD AVE NE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123877",
            "telephone_number": "770-994-9326",
            "fax_number": "770-994-4747"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "410 W 10th Ave",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432101240",
            "country_code": "US",
            "telephone_number": "614-293-8000",
            "fax_number": "614-293-3124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTKE",
        "first_name": "ANGELA",
        "middle_name": "FEAZEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-02",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35.123208",
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "GA",
            "license": "057540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

Verify at the official NPI Registry.