Active NPI
Matthew Wada
- Addiction (Substance Use Disorder) Counselor
- Pasadena, CA
National Provider Identifier
1114654506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 15530-RAC
- Practice address
- 1230 N Marengo Ave
Pasadena, CA 91103-2217 - Phone
- (626) 633-2593
- NPI assigned
- Aug 4, 2022
- Last updated
- Dec 18, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 15530-RAC | CA | Primary |
| Technician | 374700000X | NU |
Addresses
Primary practice location
1230 N Marengo Ave
Pasadena, CA 91103-2217
Mailing address
1230 N Marengo Ave
Pasadena, CA 91103-2217
Phone (626) 633-2593
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | sage.healthagency.lacounty.gov/pc | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15530-RAC | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734480000000",
"number": "1114654506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1230 N MARENGO AVE",
"city": "PASADENA",
"state": "CA",
"postal_code": "911032217",
"telephone_number": "626-633-2593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1230 N MARENGO AVE",
"city": "PASADENA",
"state": "CA",
"postal_code": "911032217",
"telephone_number": "626-633-2593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADA",
"first_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-04",
"last_updated": "2024-12-18",
"certification_date": "2024-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "15530-RAC",
"primary": true
},
{
"code": "374700000X",
"taxonomy_group": "",
"desc": "Technician",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "sage.healthagency.lacounty.gov/pc",
"affiliation": "N",
"endpointDescription": "LA County EHR",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "sage.healthagency.lacounty.gov/pc",
"address_1": "1230 N Marengo Ave",
"city": "Pasadena",
"state": "CA",
"country_code": "US",
"postal_code": "911032217",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Pasadena, CA
- W Allan Edmiston MD a Medical Corporation
- W. Frederick Stephens,DDS,Inc (The Pacific Coast Center for Oral & Facial Surgery)
- W.James Henneberg, M.D. Inc.
- Jamie Fauve Waarbroek, PMNHNP-BC
- Elizabeth Wachsman, M.D.
- Takashi Michael Wada, MD
- Carley Ann Wade, OTR/L
- Levi Carl Wade
- Vanessa Mary Wade, LVN
- Tina Godwin Wadiwala, D.O.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.