Individual provider Active NPI

Susanne E Matthys-Ollodart, M.D.

  • Pediatrics Physician
  • Tacoma, WA
National Provider Identifier
1508831702
Registry record updated Nov 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD00035005 Issued in WA
Practice address
1530 S Union Ave
Suite 1
Tacoma, WA 98405-1954
Phone
(253) 759-3333
Fax
(253) 759-1415
NPI assigned
Feb 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD00035005 WA Primary

Addresses

Primary practice location

1530 S Union Ave
Suite 1
Tacoma, WA 98405-1954

Mailing address

1530 S Union Ave
Suite 1
Tacoma, WA 98405-1954
Phone (253) 759-3333

Other identifiers 1

IdentifierTypeStateIssuer
8208092MedicaidWA

Other names 1

  • Susanne Matthys Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141217000944 WA Practitioner - Pediatric Medicine 3274856554 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince Nov 3, 2014 Accepting new patients
Multicare Health System Pediatrics CurrentSince Nov 3, 2014 Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

200 Lilly Rd NE
Ste C
Olympia, WA 98506
Phone (360) 918-8336

Interoperability endpoints

  • Direct secure messaging: susanne.matthys-ollodar.1@28114.direct.athenahealth.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415318400000",
    "number": "1508831702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 S UNION AVE",
            "address_2": "SUITE 1",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984051954",
            "telephone_number": "253-759-3333",
            "fax_number": "253-759-1415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 S UNION AVE",
            "address_2": "SUITE 1",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984051954",
            "telephone_number": "253-759-3333",
            "fax_number": "253-759-1415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTHYS-OLLODART",
        "first_name": "SUSANNE",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-21",
        "last_updated": "2014-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00035005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8208092",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSANNE",
            "last_name": "MATTHYS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.