Melissa Troi Mateo, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA61222414 Issued in WA

Practice address

1515 E Columbia St
Othello, WA 99344-1846

Phone

(509) 488-5256

Fax

(509) 488-9939

NPI assigned

Aug 17, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Melissa Troi Keller Former name

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Physician Assistant

Education

University of Washington School of Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Columbia Basin Health AssociationGroup PAC ID 4486564309, 44 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Columbia Basin Health Association

  • Federally Qualified Health Center (FQHC)
  • Connell, WA
  • NPI 1528316379
  Medicare reassignment Care Compare group
• Columbia Basin Health Association

  • Federally Qualified Health Center (FQHC)
  • Pasco, WA
  • NPI 1225716947
  NPD
• Columbia Basin Health Association

  • Federally Qualified Health Center (FQHC)
  • Othello, WA
  • NPI 1619915006
  NPD (past)

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

{
    "created_epoch": "1597622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670284800000",
    "number": "1235741802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E COLUMBIA ST",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "993441846",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 E COLUMBIA ST",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "993441846",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1051 Columbia Ave",
            "address_purpose": "LOCATION",
            "city": "Connell",
            "state": "WA",
            "postal_code": "993268702",
            "country_code": "US",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 Government Rd",
            "address_purpose": "LOCATION",
            "city": "Mattawa",
            "state": "WA",
            "postal_code": "993495120",
            "country_code": "US",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATEO",
        "first_name": "MELISSA",
        "middle_name": "TROI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-17",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61222414",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA61157642",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA61222414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOH LICENSE",
            "identifier": "PA61222414",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "KELLER",
            "middle_name": "TROI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Brittney Dawn Marmolejo, LMP
• Emiliano Martinez
• Isaac Martinez, PHARMD
• Jazmine Desiree Martinez, LMH-A
• Michelle Martinez
• Jessica Mae Maxey, MA, CCC-SLP
• Richard A Maywald
• Robert Lee McCrorie, PA-C
• Kristen A. McCulloch-Stevens, RN
• Sara McPherson

• Medical Physician Assistant in Othello, WA
• Providers in Othello, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.