Kimberly Matta, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA8479 Issued in TX

Practice address

18400 Katy Fwy
Suite 530
Houston, TX 77094-1286

Phone

(281) 717-4003

Fax

(281) 206-7597

NPI assigned

Oct 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Kimberly Brey Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2015 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Ernest G. Layton Jr. MD PA

  • Ambulatory Surgical Clinic/Center
  • Houston, TX
  • NPI 1144626060
  NPD (past)

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547769600000",
    "number": "1407949985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 GESSNER RD STE 2200",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770242583",
            "telephone_number": "713-337-5277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18400 KATY FWY",
            "address_2": "SUITE 530",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770941286",
            "telephone_number": "281-717-4003",
            "fax_number": "281-206-7597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTA",
        "first_name": "KIMBERLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2019-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA08479",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "2204",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA8479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "322814001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "BREY",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ayaka Matsumura
• Ryoichi Matsunuma
• Takahiro Matsuo, MD
• Mary Karen Christine Matt, DDS
• Eduardo J Matta, MD
• Madonna Matta, PT
• Pierre A. Matta, MA, LMFT
• Christina H Mattamal, PHARMD
• Samer G Mattar, MD
• Karen Ann Matter

• Physician Assistant in Houston, TX
• Providers in Houston, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.