Adelina Matatova, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2 N Central Ave Ste 120
Phoenix, AZ 85004-2972

Phone

(602) 296-4060

Fax

(602) 296-4146

NPI assigned

Aug 17, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 8

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Epiphany Dermatology of Arizona LLCGroup PAC ID 9830181361, 26 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

82.18 of 100Reported as group

Quality

65.23

Promoting interoperability

100

Improvement activities

40

Cost

75.35

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: adelina.matatova@epiphanyderm.emadirect.md

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.

• Epiphany Dermatology of Arizona, LLC

  • Dermatology Physician
  • Peoria, AZ
  • NPI 1457465858
  Medicare reassignment Care Compare group
• Academy Dermatologists Group LLC

  • Procedural Dermatology Physician
  • Tucson, AZ
  • NPI 1144588047
  NPD (past)
• Regency Reconstruction PLLC

  • Plastic and Reconstructive Surgery Physician
  • Phoenix, AZ
  • NPI 1972086924
  NPD (past)

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

{
    "created_epoch": "1534464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679270400000",
    "number": "1316427479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 RANCH ROAD 2222, BUILDING 1, STE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78730",
            "telephone_number": "512-628-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 N CENTRAL AVE STE 120",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850042972",
            "telephone_number": "602-296-4060",
            "fax_number": "602-296-4146"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2145 E Warner Rd Ste 104",
            "address_purpose": "LOCATION",
            "city": "Tempe",
            "state": "AZ",
            "postal_code": "852843549",
            "country_code": "US",
            "telephone_number": "480-664-9443",
            "fax_number": "480-664-9378",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20860 N Tatum Blvd Ste 290",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850504282",
            "country_code": "US",
            "telephone_number": "480-563-1144 x48056",
            "fax_number": "480-563-2371",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3011 S Lindsay Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852954333",
            "country_code": "US",
            "telephone_number": "480-726-2500",
            "fax_number": "480-726-2131",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3130 E Baseline Rd Ste 107",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852047290",
            "country_code": "US",
            "telephone_number": "480-345-1980",
            "fax_number": "480-926-1721",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15256 N 75th Ave Ste 360",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "AZ",
            "postal_code": "853814761",
            "country_code": "US",
            "telephone_number": "623-486-2424",
            "fax_number": "623-486-4324",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "270 E Hunt Hwy Ste A-2",
            "address_purpose": "LOCATION",
            "city": "San Tan Valley",
            "state": "AZ",
            "postal_code": "851434962",
            "country_code": "US",
            "telephone_number": "480-882-2222 x48072",
            "fax_number": "480-882-2220",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10240 W Indian School Rd Ste 115",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850375905",
            "country_code": "US",
            "telephone_number": "623-243-9077",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATATOVA",
        "first_name": "ADELINA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-17",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AZ",
            "license": "7629170001",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AZ",
            "license": "7034950001",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AZ",
            "license": "7047150001",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AZ",
            "license": "7209350001",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AZ",
            "license": "7057360001",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AZ",
            "license": "7045160001",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AZ",
            "license": "7046960001",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Xavier Mata, D.M.D., M.S.
• Matai LLC
• Miguel Angel Matamoros
• Maria Matas, FNP
• Tim Matatov, M.D.
• Kaavya Reddy Matatova, MD
• Cynthia Matcha, LPC
• John W. Matchette, PA-C
• Daisy Coral Mateo Antuna
• Roberta Matern, MD

• Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.