NPIMap

Organization Active NPI

Arete Medical LLC

  • Plastic Surgery Physician
  • Salem, OR
National Provider Identifier
1447834064
Registry record updated Mar 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
ARETE MEDICAL LLC
Practice address
350 Miller St SE Ste 200
Salem, OR 97302-4272
Phone
(503) 400-3434
NPI assigned
May 10, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2022

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

Authorized official

Name
Gennaya Lynn Mattison, M.D.NPI 1407266455
Title
Owner
Phone
(503) 400-3434

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X Primary
Medical Specialty Clinic/Center 261QM2500X

Addresses

Primary practice location

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

Mailing address

350 Miller St SE Ste 200
Salem, OR 97302-4272
Phone (503) 400-3434

Other names 1

  • Arete Plastic Surgery Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220302001133 OR Part B Supplier - Clinic/Group Practice 8123412475 Receives reassigned benefits from 1 practitioner
Practice locations: Salem, OR

National Provider Directory

National Provider Directory

Locations

350 Miller St SE
Ste 200
Salem, OR 97302
Phone (503) 400-3434

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1620604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646611200000",
    "number": "1447834064",
    "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": {
        "organization_name": "ARETE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-10",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A",
        "authorized_official_last_name": "MATTISON",
        "authorized_official_first_name": "GENNAYA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-400-3434",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arete Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.