Angela Fay Mata, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301086164 Issued in MI

Practice address

22201 Moross Rd Ste 270
Detroit, MI 48236-2175

Phone

(313) 343-3481

Fax

(313) 343-7937

NPI assigned

Nov 14, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Other names 1

• Angela Fay Mata-Angelocci Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amataangelocci1140474@direct.hfhs.org

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.

• Henry Ford Health St. John Hospital

  • Podiatrist
  • Harrison Township, MI
  • NPI 1043478910
  NPD
• Henry Ford Health St. John Hospital

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1912965088

  Pediatrics

  NPD
• Pathology Specialists of Southeast Michigan PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Detroit, MI
  • NPI 1023100500
  NPD
• Henry Ford Health St. John Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168
  NPD
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403654400000",
    "number": "1366623704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22201 MOROSS RD STE 270",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362175",
            "telephone_number": "313-343-3481",
            "fax_number": "313-343-7937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22201 MOROSS RD STE 270",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362175",
            "telephone_number": "313-343-3481",
            "fax_number": "313-343-7937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATA",
        "first_name": "ANGELA",
        "middle_name": "FAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-14",
        "last_updated": "2014-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301086164",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35097933",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0053325",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP",
            "identifier": "0H208910",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9761739",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARAMOUNT",
            "identifier": "07249",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERIDIAN",
            "identifier": "72300",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "MATA-ANGELOCCI",
            "middle_name": "FAY",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Shelby Ann Masters, MD
• Alyssa Masterson, FNP
• Raywa Masti, MD
• Julia Mastracci, DDS
• Carli Nohra Mastronardi, MA
• Raveena Mata, MD
• Arber Matai
• Bayan Matarneh, MD
• Elise Matatall
• Kristopher Michael Matelic, CRNA

• Pediatrics Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2014; 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.