Izabella Matatova

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

625 Old Peachtree Rd NW
Suwanee, GA 30024-2937

Phone

(678) 225-7500

NPI assigned

Mar 6, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: izabella.matatova.1@25899.direct.athenahealth.com

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.

• Psychiatric Professionals of Georgia, LLC

  • Psychiatry Physician
  • Suwanee, GA
  • NPI 1396277968
  Medicare reassignment

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

{
    "created_epoch": "1646524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646524800000",
    "number": "1306593751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 OLD PEACHTREE RD NW",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242937",
            "telephone_number": "678-225-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 OLD PEACHTREE RD NW",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242937",
            "telephone_number": "678-225-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATATOVA",
        "first_name": "IZABELLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-06",
        "last_updated": "2022-03-06",
        "certification_date": "2022-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Grace Thomas, PH.D.,P.C.
• Mary Loretta House, LLC
• Shanae Mason, PA-C
• Nicholas Massa
• Jennifer Masters
• Maternal and Family Medicine Ctr
• Maternal Medicine Ctr
• Ellen Matthews, RN
• Maxfacesurgery LLC
• Claude I Mayembe Sr., DPM

• Student in an Organized Health Care Education/Training Program in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Student in an Organized Health Care Education/Training Program in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.