Penn L Mattox, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA380 Issued in FL

Practice address

4215 Edgewater Dr
Orlando, FL 32804-2206

Phone

(407) 539-2000

Fax

(407) 398-0050

NPI assigned

Jan 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 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• 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": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1104805001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1955 1ST AVENUE NORTH",
            "address_2": "SUITE 101",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337138907",
            "telephone_number": "727-822-3500",
            "fax_number": "727-822-3228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4215 EDGEWATER DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328042206",
            "telephone_number": "407-539-2000",
            "fax_number": "407-398-0050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1955 1st Avenue North",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Saint Petersburg",
            "state": "FL",
            "postal_code": "337138907",
            "country_code": "US",
            "telephone_number": "727-822-3500",
            "fax_number": "727-822-3228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTOX",
        "first_name": "PENN",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-10",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA3280",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2920905 00",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL MCARE - QSS SOUTHEAST CLINICAL SERVICES",
            "identifier": "E4034Y",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paulette Mary Mattia, B.S., D.C.
• Kyla Nicole June Mattingly
• Tod Alan Mattis, M.D.
• Kenneth Mattison, CRNA
• Salia Mattison
• Kary Constance Mattson
• Sara Mattson
• Rachel Mattsson
• Skyler Ashleigh Matulis, BT
• Julie Marie Matura, M.A.,CCC-SLP

• Surgical Physician Assistant in Orlando, FL
• Providers in Orlando, 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 17, 2018; 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.