Patric William Mattek, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2508-57 Issued in WI

Practice address

970 S Silver Lake St Ste 102
Oconomowoc, WI 53066-3802

Phone

(262) 569-7100

Fax

(262) 567-6295

NPI assigned

Oct 5, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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 and National Provider Directory roles.

• PKM Clinical Solutions LLC

  • Psychologist
  • Muskego, WI
  • NPI 1295202976
  NPD Authorized official
• County of Walworth

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Elkhorn, WI
  • NPI 1588733307
  Medicare reassignment

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681171200000",
    "number": "1477540243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W206S7867 PASADENA DR",
            "city": "MUSKEGO",
            "state": "WI",
            "postal_code": "531509532",
            "telephone_number": "262-971-5015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 S SILVER LAKE ST STE 102",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663802",
            "telephone_number": "262-569-7100",
            "fax_number": "262-567-6295"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "W206S7867 Pasadena Dr",
            "address_purpose": "LOCATION",
            "city": "Muskego",
            "state": "WI",
            "postal_code": "531509532",
            "country_code": "US",
            "telephone_number": "262-971-5015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTEK",
        "first_name": "PATRIC",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "2508-57",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40938300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stan L Markus, MD
• Lorraine Marquette, RN
• Thomas K. Marsh, O.D.
• Noelle Martin, COTA
• Dean Louis Martinelli, MD
• Nancy J Matthews, P.A.
• Colleen June Matthys
• Ajalee Matus
• Karen Maurer, PA-C
• Kristen L May, PT

• Psychologist in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2023; 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.