Mattison Angove, PA-C
Individual provider Active NPI Physician Assistant · Jamestown, NY
NPI 1255210480 · NPPES record last updated Mar 13, 2026
Key facts
- NPI
- 1255210480
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 034422 (NY)
- Practice address
- 1465 Foote Avenue Ext
Jamestown, NY 14701-9383 - Phone
- (716) 526-4041
- NPI assigned
- Sep 1, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
107 Institute St
Jamestown, NY 14701-6628
987 R C Hoag Dr
Salamanca, NY 14779-1365
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251030002686 | NY | Practitioner - Physician Assistant | 0840789731 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 034422 | NY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Chautauqua Center, Inc | Current |
Accepting new patients | |
| The Chautauqua Center, Inc | Current |
Accepting new patients | |
| Jamestown Psychiatric PC | Past |
Accepting new patients | |
| Jamestown Psychiatric PC | Past |
Accepting new patients |
Locations
1134 Central Ave
Dunkirk, NY 14048
Phone (716) 366-6036
107 Institute St
Jamestown, NY 14701
Phone (716) 484-4334
Interoperability endpoints
- mattison.wallin.1@22211.direct.athenahealth.com
- https://api.platform.athenahealth.com/22211/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 034422 | NY | Yes |
Addresses
Primary practice location
1465 Foote Avenue Ext
Jamestown, NY 14701-9383
Mailing address
1465 Foote Avenue Ext
Jamestown, NY 14701-9383
Phone (716) 526-4041
Other practice location 1
987 R C Hoag Dr
Salamanca, NY 14779-1365
Phone (716) 945-5894
Other practice location 2
275 Thomas Indian School Dr
Irving, NY 14081-9341
Phone (716) 532-5582
Other names
- Mattison Wallin
Other providers in Jamestown, NY
- Rachel Anderson
- Sandra Lee Anderson
- Valerie Katherine Anderson
- Amanda Catherine Andrews
- Olivia Andriaccio
- Anthony J Peppy & Samuel J Peppy DDS PC
- Frank Arnal
- Debra Lynn Arndt
- Eric David Arnone
- Arthur Laury Opticians
All providers in Jamestown, NY · Physician Assistant in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.