Chantal Tiffany Therese Mattar, NP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

4704288255 Issued in MI

Practice address

12121 Broadstreet Ave
Detroit, MI 48204-1550

Phone

(313) 824-1000

NPI assigned

May 16, 2024

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 MI

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

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Nephrology Associates of Michigan PCGroup PAC ID 8729136486, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trinity Health Livingston Hospital Hospital, Howell, MI, CCN 230069
• Trinity Health Ann Arbor Hospital Hospital, Ann Arbor, MI, CCN 230156

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: cmattar739686@direct.hfhs.org
• Direct secure messaging: cmattar72688@direct.acumenmd.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.

• Nephrology Associates of Michigan PC

  • Nephrology Physician
  • Ypsilanti, MI
  • NPI 1922249366
  Medicare reassignment Care Compare group NPD
• Detroit Wayne County Health Authority

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
  • NPI 1245182963
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Saint Joseph Mercy Livingston Hospital

  • General Acute Care Hospital
  • Brighton, MI
  • NPI 1093748642
  Care Compare affiliation
• St Joseph Mercy Hospital

  • General Acute Care Hospital
  • Ypsilanti, MI
  • NPI 1780658443
  Care Compare affiliation

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

{
    "created_epoch": "1715817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728172800000",
    "number": "1366291809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12121 BROADSTREET AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482041550",
            "telephone_number": "313-824-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12121 BROADSTREET AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482041550",
            "telephone_number": "313-824-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10809 Mack Ave",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482142119",
            "country_code": "US",
            "telephone_number": "313-824-1000 x1",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTAR",
        "first_name": "CHANTAL",
        "middle_name": "TIFFANY THERESE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-16",
        "last_updated": "2024-10-06",
        "certification_date": "2024-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704288255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Nikko Matsumoto
• Mykola Matsyuk, PT
• Taylor Jane Matt
• Kathryn Matta
• Raghuram Matta, MD
• Matter Health of Michigan PLLC
• Gina Matteucci, RD
• Matthew Nye DDS PLLC
• Aisha Amina Matthews
• Caneisaya Matthews, MD

• Acute Care Nurse Practitioner in Detroit, MI
• Providers in Detroit, MI by specialty
• Acute Care Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2024; 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.