Theodore Frank Matejka, ARNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

ARNP3074712 Issued in FL

Practice address

1150 Red John Dr
Daytona Beach, FL 32124-1016

Phone

(386) 236-1711

Fax

(386) 226-0200

NPI assigned

Jul 5, 2005

Last updated

Mar 26, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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 FL

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

Nurse Practitioner

Practice roles

Locations

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.

• Sma Healthcare Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Daytona Beach, FL
  • NPI 1356329163
  Medicare reassignment NPD
• Sma Healthcare, Inc

  • Federally Qualified Health Center (FQHC)
  • Daytona Beach, FL
  • NPI 1255950168
  NPD
• Sma Healthcare Inc

  • Psychiatric Hospital
  • Daytona Beach, FL
  • NPI 1750369666
  NPD (past)

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364256000000",
    "number": "1396742490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 RED JOHN DR",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321241016",
            "telephone_number": "386-236-1711",
            "fax_number": "386-226-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 RED JOHN DR",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321241016",
            "telephone_number": "386-236-1711",
            "fax_number": "386-226-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATEJKA",
        "first_name": "THEODORE",
        "middle_name": "FRANK",
        "name_prefix": "Mr.",
        "credential": "ARNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2013-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "ARNP3074712",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "ARNP3074712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chyna Jennell Mason
• Corey L Massey, BCBA
• Douglas Lewis Massingill, D.D.S.
• Angela Marie Mastropiero, RCSWI
• Samsor Mateen, M.D.
• Rodrigo Bleza Mateo, MD
• Jennifer Lynn Matey, PA-C
• Nancy S Mather, ARNP-C
• Susan P. Mathew, M.D.
• Robert Mathis, ARNP

• Psychiatric/Mental Health Nurse Practitioner in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2013; 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.