NPIMap

Organization Active NPI

B Mata LLC

Doing business as Centro Medico San Lucas

  • Geriatric Medicine (Family Medicine) Physician
  • Gainesville, GA
National Provider Identifier
1295366292
Registry record updated Jan 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
B MATA LLC
Doing business as
Centro Medico San Lucas
Practice address
1631 Atlanta Hwy
Gainesville, GA 30504-5942
Phone
(770) 718-1517
Fax
(770) 718-1518
NPI assigned
Jan 28, 2020
Last updated
Jan 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2020

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

Authorized official

Name
Byron Oswaldo Mata Gonzalez, MDNPI 1326206897
Title
Owner
Phone
(786) 427-4450

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QG0300X Primary

Addresses

Primary practice location

1631 Atlanta Hwy
Gainesville, GA 30504-5942

Mailing address

1631 Atlanta Hwy
Gainesville, GA 30504-5942
Phone (770) 718-1517

Other practice location 1

4292 Chamblee Tucker Rd
Tucker, GA 30084-2103
Phone (770) 718-1517 ext. 2

Other names 1

  • Centro Medico San Lucas Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://npiregistry.cms.hhs.gov/

National Provider Directory

National Provider Directory

Locations

1631 Atlanta Hwy
Gainesville, GA 30504
Phone (770) 718-1517

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1580169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580169600000",
    "number": "1295366292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1631 ATLANTA HWY",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305045942",
            "telephone_number": "770-718-1517",
            "fax_number": "770-718-1518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 ATLANTA HWY",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305045942",
            "telephone_number": "770-718-1517",
            "fax_number": "770-718-1518"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4292 Chamblee Tucker Rd",
            "address_purpose": "LOCATION",
            "city": "Tucker",
            "state": "GA",
            "postal_code": "300842103",
            "country_code": "US",
            "telephone_number": "770-718-1517 x2",
            "fax_number": "770-718-1518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "B MATA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-28",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A",
        "authorized_official_last_name": "MATA GONZALEZ",
        "authorized_official_first_name": "BYRON",
        "authorized_official_middle_name": "OSWALDO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-427-4450",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://npiregistry.cms.hhs.gov/",
            "affiliation": "N",
            "address_1": "1631 Atlanta Hwy",
            "city": "Gainesville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "305045942",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Centro Medico San Lucas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.