NPIMap

Organization Active NPI

MD Matt LLC

  • Adult Health Nurse Practitioner
  • Hagerstown, MD
National Provider Identifier
1508636762
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
Legal business name
MD MATT LLC
Practice address
265 Mill St Ste 700
Hagerstown, MD 21740-6181
Phone
(443) 559-4137
NPI assigned
Jan 8, 2024
Last updated
Jan 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Authorized official

Name
William Shaffer
Title
Owner
Phone
(443) 220-6122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X Primary

Addresses

Primary practice location

265 Mill St Ste 700
Hagerstown, MD 21740-6181

Mailing address

625 S Clinton St
Baltimore, MD 21224-4009

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210701000406 MD Part B Supplier - Clinic/Group Practice 6800297524 Receives reassigned benefits from 11 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Frederick, MD; Owings Mills, MD; Linthicum Heights, MD; Hagerstown, MD; Baltimore, MD

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
MD Matt LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

265 Mill St
Ste 700
Hagerstown, MD 21740
Phone (240) 347-4981

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1508636762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 S CLINTON ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212244009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 MILL ST STE 700",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406181",
            "telephone_number": "443-559-4137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD MATT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "SHAFFER",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-220-6122"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; 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.