Individual provider Active NPI

Joseph Mattana, MD

  • Nephrology Physician
  • Mineola, NY
National Provider Identifier
1538230628
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
57022 Issued in CT
Practice address
200 Old Country Rd
Suite 135
Mineola, NY 11501-4235
Phone
(516) 663-2169
Fax
(516) 663-2179
NPI assigned
Nov 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 181224 NY
Nephrology Physician 207RN0300X 57022 CT Primary

Addresses

Primary practice location

200 Old Country Rd
Suite 135
Mineola, NY 11501-4235

Mailing address

2800 Main St
Bridgeport, CT 06606-4201
Phone (475) 210-5022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CT2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20071112000278 NY Practitioner - Internal MedicinePractitioner - Nephrology 4486742350 Reassigns benefits to 2 organizations
I20171030003364 CT Practitioner - NephrologyPractitioner - Internal Medicine 4486742350 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Affiliate Group of New York PCGroup PAC ID 4688098833, 1,222 clinicians

Practice addresses (Care Compare)

506 Lenox Ave
New York, NY 10037-1802
Phone (212) 939-1840

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Metropolitan Medical Practice Plan PC CurrentSince Nov 24, 2020 Accepting new patients
Physician Affiliate Group of New York PC CurrentSince Mar 1, 2024 Accepting new patients
Neighborhood Health, Inc. CurrentSince Sep 5, 2017 Accepting new patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Dec 1, 2020 Accepting new patients
Hartford Healthcare Medical Group Specialists, PLLC CurrentSince Dec 1, 2020 Accepting new patients

Locations

2800 Main St
Bridgeport, CT 06606
Phone (203) 386-0366

2660 Main St
Ste 216
Bridgeport, CT 06606
Phone (203) 335-0919

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

1901 1st Ave
Rm 5M44
New York, NY 10029
Phone (212) 423-6262

1901 1st Ave
New York, NY 10029
Phone (212) 230-6262

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: josephmattana@nslijmedgr.allscriptsdirect.net

Organizations & group practices 5

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1538230628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066064201",
            "telephone_number": "475-210-5022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 OLD COUNTRY RD",
            "address_2": "SUITE 135",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014235",
            "telephone_number": "516-663-2169",
            "fax_number": "516-663-2179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTANA",
        "first_name": "JOSEPH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "181224",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CT",
            "license": "57022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.