Mallory Nichole Matusik, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71012811A Issued in IN

Practice address

519 N Halleck St
Demotte, IN 46310-9553

Phone

(219) 987-7750

NPI assigned

Jul 21, 2022

Last updated

Jul 23, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21537/brand/1/csg/1/fhir/r4
• Direct secure messaging: mallory.matusik.1@21537.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Leestma Medical Clinic, Inc

  • Family Medicine Physician
  • Demotte, IN
  • NPI 1487986451
  NPD

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

{
    "created_epoch": "1658361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658534400000",
    "number": "1386379501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9811 W 145TH AVE",
            "city": "CEDAR LAKE",
            "state": "IN",
            "postal_code": "463037258",
            "telephone_number": "219-484-7683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 N HALLECK ST",
            "city": "DEMOTTE",
            "state": "IN",
            "postal_code": "463109553",
            "telephone_number": "219-987-7750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATUSIK",
        "first_name": "MALLORY",
        "middle_name": "NICHOLE",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-21",
        "last_updated": "2022-07-23",
        "certification_date": "2022-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28229514A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71012811A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Little Green Thumbs ABA LLC
• Daron Keith Lynch, D.C.
• Major Hospital (Aperion Care Demotte)
• Maria Elena Marania, RPT
• Jessica Maria Marinceski
• Jennifer L McCloskey-Styka, LMHC
• Nicole M Merry
• Candice Milsop, CMT
• Madison Mulder
• Jennifer L Musch, PTA

• Family Nurse Practitioner in Demotte, IN
• Providers in Demotte, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.