NPIMap

Individual provider Active NPI

Tiffany Anne Matonak, PA-C

  • Physician Assistant
  • Glen Burnie, MD
National Provider Identifier
1306120340
Registry record updated Jan 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0004571 Issued in MD
Practice address
305 Hospital Dr
Glen Burnie, MD 21061-5805
Phone
(410) 553-8150
NPI assigned
Oct 10, 2011
Last updated
Jan 23, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0004571 MD Primary

Addresses

Primary practice location

305 Hospital Dr
Glen Burnie, MD 21061-5805

Mailing address

305 Hospital Dr
Glen Burnie, MD 21061-5805

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20111107000730 MD Practitioner - Physician Assistant 4183897119 Reassigns benefits to 3 organizations
I20250228002712 DC Practitioner - Physician Assistant 4183897119 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Luminis Health Medical Group, LLCGroup PAC ID 2860447315, 540 clinicians

Practice addresses (Care Compare)

2000 Medical Pkwy
Annapolis, MD 21401-3742
Phone (443) 481-1358

2001 Medical Pkwy
Annapolis, MD 21401-3280
Phone (443) 481-1000

2003 Medical Pkwy
Annapolis, MD 21401-3081

2003 Medical Pkwy Wayson Pavillion
Advanced Internal Medicine Residenc
Annapolis, MD 21401-3081
Phone (443) 951-4286

2540 Centreville Rd
Centreville, MD 21617-2681
Phone (410) 822-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C0004571MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Luminis Health Medical Group, LLC CurrentSince Apr 15, 2025 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Apr 15, 2025 Accepting new patients
Kalihi Palama Health Center Current Accepting new patients
University of Maryland Community Medical Group, Inc. CurrentSince Jan 1, 2016 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Apr 15, 2025 Accepting new patients
University of Maryland Surgcial Assoc PA Past Accepting new patients
Arundel Physicians Associates, LLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Baltimore Washington Medical Center Inc. Past Accepting new patients

Locations

2000 Medical Pkwy
Ste 409
Annapolis, MD 21401
Phone (443) 481-5136

2003 Medical Pkwy
Ste 301
Annapolis, MD 21401
Phone (443) 481-3366

4175 N Hanson Ct
Ste 201
Bowie, MD 20716
Phone (443) 481-1199

2540 Centreville Rd
Centreville, MD 21617
Phone (410) 758-4432

219 S Washington St
Easton, MD 21601

300 Hospital Dr
Ste 126
Glen Burnie, MD 21061
Phone (410) 787-4897

305 Hospital Dr
Glen Burnie, MD 21061
Phone (410) 553-8100

305 Hospital Dr
Lowr
Glen Burnie, MD 21061
Phone (410) 553-8359

305 Hospital Dr
Ste 304
Glen Burnie, MD 21061
Phone (410) 266-2725

Interoperability endpoints

  • Direct secure messaging: thamilton14073@direct.umm.edu
  • Direct secure messaging: tiffany.hamilton@hawaiihie.medicity.net

Organizations & group practices 12

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.

Hospital & facility affiliations 3

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": "1318204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485129600000",
    "number": "1306120340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 HOSPITAL DR",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 HOSPITAL DR",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615805",
            "telephone_number": "410-553-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATONAK",
        "first_name": "TIFFANY",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-10",
        "last_updated": "2017-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0004571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

Verify at the official NPI Registry.