Elizabeth A Mattesi, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA3294 Issued in FL

Practice address

1223 Gateway Dr
Melbourne, FL 32901

Phone

(321) 728-6002

Fax

(321) 676-9731

NPI assigned

May 10, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• QSS-Southeast Clinical Services LLC

  • Surgery Physician
  • Orlando, FL
  • NPI 1740521137
  NPD (past)
• Southeastern Clinical Services,Inc.

  • Surgical Physician Assistant
  • Orlando, FL
  • NPI 1033162011
  NPD (past)

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583712000000",
    "number": "1093765323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 S FISKE BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554306",
            "telephone_number": "321-728-6002",
            "fax_number": "321-676-9731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1223 GATEWAY DR",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "32901",
            "telephone_number": "321-728-6002",
            "fax_number": "321-676-9731"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4215 Edgewater Dr",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328042206",
            "country_code": "US",
            "telephone_number": "973-826-8080",
            "fax_number": "888-972-6480",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "699 W Cocoa Beach Cswy Ste 505",
            "address_purpose": "LOCATION",
            "city": "Cocoa Beach",
            "state": "FL",
            "postal_code": "329313562",
            "country_code": "US",
            "telephone_number": "321-868-4100",
            "fax_number": "321-868-8374",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTESI",
        "first_name": "ELIZABETH",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA3294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019045900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "E3398Y",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL RR MEDICARE",
            "identifier": "P01165532",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adriana Matos Torres
• Anna Matos
• Jessica Matos, PMHNP
• Matthew L Mattern, M.D.
• Christina Ruthann Mattes, APRN
• Angela Matthews, D.O.
• Kristin Matthews, MS, CCC-SLP
• Tavy Matthews
• Alison Matthiesen-Wahlstedt, LMT
• Amanda Catherine Mattick, MA, LMHC, CAP

• Surgical Physician Assistant in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.