Individual provider Active NPI

Mandeep S Matta, M.D.

  • Infectious Disease Physician
  • Fort Worth, TX
National Provider Identifier
1295053072
Registry record updated Jun 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
256906 Issued in NY
Practice address
1350 S Main St
Fort Worth, TX 76104-7611
Phone
(817) 927-3701
Fax
(817) 920-6924
NPI assigned
May 4, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X 256906 NY Primary
Internal Medicine Physician 207R00000X 256906 NY

Addresses

Primary practice location

1350 S Main St
Fort Worth, TX 76104-7611

Mailing address

1617 Hemphill St
Fort Worth, TX 76104-4709
Phone (817) 927-3701

Other identifiers 1

IdentifierTypeStateIssuer
03401810MedicaidNY

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150309001992 TX Practitioner - Infectious DiseasePractitioner - Internal Medicine 8921285149 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious DiseaseAlso: Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acclaim Physician Group IncGroup PAC ID 4587963582, 520 clinicians

Practice addresses (Care Compare)

1350 S Main St FL
1 Healing Wings/Infectious Disease
Fort Worth, TX 76104-7611
Phone (817) 702-3701

Hospital & facility affiliations

  • JPS Health Network Hospital, Fort Worth, TX, CCN 450039

Merit-based Incentive Payment System (MIPS)

Final score
96.38 of 100Reported as group
Quality
80.41
Promoting interoperability
100
Improvement activities
40
Cost
78.69

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
256906NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Acclaim Physician Group, Inc Internal Medicine CurrentSince May 1, 2016 Accepting new patients

Locations

1350 S Main St
Fl 1
Fort Worth, TX 76104
Phone (817) 702-3701

1350 S Main St
Ste 1600
Fort Worth, TX 76104
Phone (817) 702-3701

1617 Hemphill St
Ft Worth, TX 76104
Phone (817) 702-3381

1500 S Main St
Ft Worth, TX 76104
Phone (817) 921-3431

1350 S Main St
Ft Worth, TX 76104
Phone (817) 702-8400

Organizations & group practices 1

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 1

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": "1272931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434412800000",
    "number": "1295053072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1617 HEMPHILL ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044709",
            "telephone_number": "817-927-3701",
            "fax_number": "817-920-6924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 S MAIN ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761047611",
            "telephone_number": "817-927-3701",
            "fax_number": "817-920-6924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTA",
        "first_name": "MANDEEP",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-04",
        "last_updated": "2015-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NY",
            "license": "256906",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "256906",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03401810",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.