James Frederick Mattson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

27798 Issued in CA

Practice address

499 Chestnut St
Suite C
Fort Bragg, CA 95437-4521

Phone

(707) 964-5616

Fax

(707) 964-5917

NPI assigned

Oct 23, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

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 2

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1093898215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 429",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954374521",
            "telephone_number": "707-964-5616",
            "fax_number": "707-964-5917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499 CHESTNUT ST",
            "address_2": "SUITE C",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954374521",
            "telephone_number": "707-964-5616",
            "fax_number": "707-964-5917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTSON",
        "first_name": "JAMES",
        "middle_name": "FREDERICK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "27798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2227798",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MPIN",
            "identifier": "COAST5616",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erika Lynn Malsom, MFT-INTERN
• Mark David Levine MD, Fort Bragg Professional Corporation
• Joseph E Martin, PA
• Lucila Martinez
• Linnea Marie Matthews, FNP
• Marcie Mliss Maxham, DDS
• Thais Mazur, OTR
• Doris A McConnell
• Teresa Ann McDonald, FNP
• Tara Ellen McLeer, MD

• Dentist in Fort Bragg, CA
• Providers in Fort Bragg, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.