Materia Medica

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

PA 9104124 Issued in FL

Legal business name

MATERIA MEDICA

Practice address

2804 Del Prado Blvd S Ste 109
Cape Coral, FL 33904-7283

Phone

(239) 223-0039

NPI assigned

Dec 10, 2015

Organization subpart

No

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

Authorized official

Name

Matthew Donnelly, PA-CNPI 1336341551

Title

Owner

Phone

(239) 223-0039

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

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

• Matthew F Donnelly, PAC

  • Physician Assistant
  • Cape Coral, FL
  • NPI 1336341551
  Medicare reassignment Authorized official
• Mary Donnelly, MA, LPC

  • Mental Health Counselor
  • Cape Coral, FL
  • NPI 1205883386
  NPD (past)

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

{
    "created_epoch": "1449705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449705600000",
    "number": "1538534888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 152974",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339152974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2804 DEL PRADO BLVD S STE 109",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339047283",
            "telephone_number": "239-223-0039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATERIA MEDICA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-10",
        "last_updated": "2015-12-10",
        "status": "A",
        "authorized_official_last_name": "DONNELLY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-223-0039",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "FL",
            "license": "PA 9104124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lydia Masters, BEHAVIOR ASSISTANT
• Cassidy Masterson
• Kathleen Masterson
• Randall James Mastny, PHARMD
• Yanet Mateo Castillo
• Maternal Fetal Medicine of Southwest Florida
• Liubys Mateu Izquierdo
• Antony Mathew, M.D.
• Nimmi Marie Mathews, DO
• Maria Karla Matos Bernal

• Preferred Provider Organization in Cape Coral, FL
• Providers in Cape Coral, FL by specialty
• Preferred Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2015; 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.