Individual provider Active NPI

Winfred Kemunto Matonda

  • Family Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1144853797
Registry record updated Feb 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
AP144055 Issued in TX
Practice address
1301 Pennsylvania Ave
Fort Worth, TX 76104-2122
Phone
(817) 250-2661
NPI assigned
Feb 21, 2020
Last updated
Feb 21, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X AP144055 TX Primary

Addresses

Primary practice location

1301 Pennsylvania Ave
Fort Worth, TX 76104-2122

Mailing address

1301 Pennsylvania Ave
Fort Worth, TX 76104-2122
Phone (817) 250-2661

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230208000034 TX Practitioner - Nurse Practitioner 6608248281 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
DHHS IHS Phoenix AreaGroup PAC ID 7810163011, 25 clinicians

Practice addresses (Care Compare)

943 Hualapai Way
Peach Springs Health Center
Peach Springs, AZ 86434-0190
Phone (928) 769-2900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS IHS Phoenix CurrentSince May 1, 2025 Accepting new patients
DHHS IHS Phoenix Area CurrentSince May 1, 2025 Accepting new patients
Maniilaq Association CurrentSince Nov 1, 2022 Accepting new patients
DHHS IHS Phoenix Area CurrentSince May 1, 2025 Accepting new patients
Maniilaq Association CurrentSince Nov 1, 2022 Accepting new patients
Irene Benn Medical Center CurrentSince May 1, 2025 Accepting new patients
DHHS IHS Phoenix Area CurrentSince May 1, 2025 Accepting new patients
Maniilaq Association Current Accepting new patients
Maniilaq Association Past Accepting new patients

Locations

12033 Agency Rd
Parker, AZ 85344
Phone (760) 572-4137

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1582243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582243200000",
    "number": "1144853797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 PENNSYLVANIA AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042122",
            "telephone_number": "817-250-2661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PENNSYLVANIA AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042122",
            "telephone_number": "817-250-2661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATONDA",
        "first_name": "WINFRED",
        "middle_name": "KEMUNTO",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-21",
        "last_updated": "2020-02-21",
        "certification_date": "2020-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "AP144055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.