Trevor Samuel Mattarella, FNP
Individual provider Active NPI Family Nurse Practitioner · Pigeon, MI
NPI 1104337344 · NPPES record last updated Mar 26, 2021
Key facts
- NPI
- 1104337344
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 4704285057 (MI)
- Practice address
- 168 N Caseville Rd
Pigeon, MI 48755-9415 - Phone
- (989) 453-2141
- Fax
- (989) 453-2559
- NPI assigned
- Oct 16, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 11
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Saginaw Valley Medical College - NLG, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Scheurer Hospital
Practice addresses (Care Compare)
108 N Caseville Rd
Pigeon, MI 48755-9704
135 N Caseville Rd
Pigeon, MI 48755-9704
Phone (989) 453-3798
170 N Caseville Rd
Pigeion, MI 48755-9704
75 Buschlen Rd
Bad Axe, MI 48413-9177
Phone (989) 623-9300
Hospital & facility affiliations
- Scheurer Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171220000582 | MI | Practitioner - Nurse Practitioner | 6507124542 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scheurer Hospital | Current | Accepting new patients | |
| Scheurer Hospital | Past | Accepting new patients | |
| Scheurer Hospital | Past | Accepting new patients |
Locations
108 N Caseville Rd
Pigeon, MI 48755
Phone (989) 453-7301
168 N Caseville Rd
Pigeon, MI 48755
Phone (989) 453-2141
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4704285057 | MI | Yes |
Addresses
Primary practice location
168 N Caseville Rd
Pigeon, MI 48755-9415
Mailing address
168 N Caseville Rd
Pigeon, MI 48755-9415
Phone (989) 453-2141
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4704285057 | Other | MI | STATE LICENSE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | tmattarella51890@direct.covenanthealthcare.com |
Other providers in Pigeon, MI
- Ali A Khan
- Angela Lackie
- List Psychological Services, PLC
- Timothy Walter Lowthian
- Stphen Mancuso
- Kenzie Marie Maust
- Lauren McCormick
- Amanda M McSweeney
- Medical Enterprises Inc
- Medical Enterprises, Inc.
All providers in Pigeon, MI · Family Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2021. 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.