NPIMap

Individual provider Active NPI

Trevor Samuel Mattarella, FNP

  • Family Nurse Practitioner
  • Pigeon, MI
National Provider Identifier
1104337344
Registry record updated Mar 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704285057 Issued in MI
Practice address
168 N Caseville Rd
Pigeon, MI 48755-9415
Phone
(989) 453-2141
Fax
(989) 453-2559
NPI assigned
Oct 16, 2017
Last updated
Mar 26, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704285057 MI Primary

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 1

IdentifierTypeStateIssuer
4704285057OtherMISTATE LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tmattarella51890@direct.covenanthealthcare.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171220000582 MI Practitioner - Nurse Practitioner 6507124542 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Saginaw Valley Medical College - NLG, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scheurer HospitalGroup PAC ID 1456242296, 49 clinicians

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704285057MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew 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

Interoperability endpoints

  • Direct secure messaging: tmattarella51890@direct.covenanthealthcare.com

Organizations & group practices 3

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

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1508112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616716800000",
    "number": "1104337344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "168 N CASEVILLE RD",
            "city": "PIGEON",
            "state": "MI",
            "postal_code": "487559415",
            "telephone_number": "989-453-2141",
            "fax_number": "989-453-2559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "168 N CASEVILLE RD",
            "city": "PIGEON",
            "state": "MI",
            "postal_code": "487559415",
            "telephone_number": "989-453-2141",
            "fax_number": "989-453-2559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTARELLA",
        "first_name": "TREVOR",
        "middle_name": "SAMUEL",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-16",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704285057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "4704285057",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmattarella51890@direct.covenanthealthcare.com",
            "affiliation": "N",
            "address_1": "168 N Caseville Rd",
            "city": "Pigeon",
            "state": "MI",
            "country_code": "US",
            "postal_code": "487559415",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pigeon, MI

Sources for this page

Verify at the official NPI Registry.