NPIMap

Individual provider Active NPI

Mrinalini Emma Matcha, M.D.

  • Nephrology Physician
  • St. Petersburg, FL
National Provider Identifier
1114952058
Registry record updated Dec 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME102947 Issued in FL
Practice address
1700 66TH Street North
Suite 302
St. Petersburg, FL 33701
Phone
(727) 290-9899
Fax
(727) 290-9898
NPI assigned
Jul 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X ME102947 FL Primary

Addresses

Primary practice location

1700 66TH Street North
Suite 302
St. Petersburg, FL 33701

Mailing address

14134 Nephron Lane
Hudson, FL 34667
Phone (727) 863-5418

Other identifiers 1

IdentifierTypeStateIssuer
000644800MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20090327000393 FL Practitioner - Nephrology 9830172303 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
National Kidney Partners LLPGroup PAC ID 7012981350, 63 clinicians

Practice addresses (Care Compare)

14134 Nephron LN
Hudson, FL 34667-6504
Phone (727) 863-5418

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME102947FLMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
National Kidney Partners, LLP Nephrology CurrentSince Mar 1, 2009 Accepting new patients
Ochsner Clinic LLC Past Accepting new patients

Locations

14134 Nephron Ln
Hudson, FL 34667
Phone (727) 863-5418

635 4th St N
Ste 200
St Petersburg, FL 33701
Phone (727) 201-4968

2191 9th Ave N
Ste 200
St Petersburg, FL 33713
Phone (727) 327-0990

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: mmatcha77040@direct.acumenmd.com

Organizations & group practices 2

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.

Hospital & facility affiliations 10

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": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323648000000",
    "number": "1114952058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14134 NEPHRON LANE",
            "city": "HUDSON",
            "state": "FL",
            "postal_code": "34667",
            "telephone_number": "727-863-5418",
            "fax_number": "727-869-8626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 66TH STREET NORTH",
            "address_2": "SUITE 302",
            "city": "ST. PETERSBURG",
            "state": "FL",
            "postal_code": "33701",
            "telephone_number": "727-290-9899",
            "fax_number": "727-290-9898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATCHA",
        "first_name": "MRINALINI",
        "middle_name": "EMMA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2011-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME102947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000644800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St. Petersburg, FL

Sources for this page

Verify at the official NPI Registry.