Gennaya Lynn Mattison, M.D.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

198745 Issued in OR

Practice address

350 Miller St SE Ste 200
Salem, OR 97302-4272

Phone

(503) 400-3434

NPI assigned

Apr 29, 2014

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gennaya.mattison.p1@direct.leonardplasticsurg.nextgenshare.com
• Direct secure messaging: gmattison218131@secure.stcharleshealthcare.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.

• Arete Medical LLC

  • Plastic Surgery Physician
  • Salem, OR
  • NPI 1447834064
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1398729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1407266455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 MILLER ST SE STE 200",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024272",
            "telephone_number": "503-400-3434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 MILLER ST SE STE 200",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024272",
            "telephone_number": "503-400-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTISON",
        "first_name": "GENNAYA",
        "middle_name": "LYNN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-29",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "OR",
            "license": "198745",
            "primary": true
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "OR",
            "license": "198745",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "198745",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Jackson Matthews, DPM
• Paige Matthews
• Tiffany Matthews, LMT
• Charlee Sue Mattingly, B.A, QMHP
• Alina Mattison, FNP
• Edward Mattson, PHARM. D.
• Teena Matuska, PTA
• Daniel Wayne Maurer Jr.
• Heather Maurer, CADC-R
• Maurice Collada Jr. MD PC

• Plastic and Reconstructive Surgery Physician in Salem, OR
• Providers in Salem, OR by specialty
• Plastic and Reconstructive Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; 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.