Mary Grace Matin, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95021844 Issued in CA

Practice address

3090 Bristol St Ste 200
Costa Mesa, CA 92626-3061

Phone

(888) 789-9585

Fax

(562) 803-4500

NPI assigned

Sep 8, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Interoperability endpoints

• Direct secure messaging: mary.matin.1@29786.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 and National Provider Directory roles.

• Careconnectmd Ca PC

  • Family Medicine Physician
  • Costa Mesa, CA
  • NPI 1366063125
  Medicare reassignment NPD
• GN Medical Associates, Inc.

  • Family Medicine Physician
  • Costa Mesa, CA
  • NPI 1275576522
  Medicare reassignment NPD

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

{
    "created_epoch": "1662595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1427779297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3090 BRISTOL ST STE 200",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926263061",
            "telephone_number": "888-789-9585",
            "fax_number": "562-803-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3090 BRISTOL ST STE 200",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926263061",
            "telephone_number": "888-789-9585",
            "fax_number": "562-803-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATIN",
        "first_name": "MARY GRACE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-08",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95021844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabriela Mata-Barragan
• Lizeth Mateos Acevedo
• Tucker Jess Matheny, MSW, ACSW
• Julie Mathew
• Mackenzie Mathis
• Maximiliano H Matos, M.D.
• Matrix Rehabilitation, Inc.
• Jasmine Matsumoto
• Kellen Matsuno, DPT
• Matt G. Farzin DDS, Inc

• Nurse Practitioner in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.