NPIMap

Organization Active NPI

MD Matt LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hyattsville, MD
National Provider Identifier
1609547009
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
MD MATT LLC
Practice address
6401 New Hampshire Ave
Hyattsville, MD 20783-3201
Phone
(410) 364-8194
Fax
(410) 364-8194
NPI assigned
Sep 24, 2021
Last updated
Dec 30, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MD MATT LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X

Addresses

Primary practice location

6401 New Hampshire Ave
Hyattsville, MD 20783-3201

Mailing address

10220 S Dolfield Rd Ste 106
Owings Mills, MD 21117-3660
Phone (443) 559-4137

Other practice location 1

7309 Baltimore Ave Ste 219
College Park, MD 20740-3200
Phone (443) 559-4137

Other identifiers 2

IdentifierTypeStateIssuer
181014604MedicaidMD
062712289MedicaidDC

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL www.mdmatt.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241223002130 DC Part B Supplier - Clinic/Group Practice 6800297524 Receives reassigned benefits from 3 practitioners
Practice locations: Hyattsville, MD

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

  • MD Matt LLC
    • Psychiatric/Mental Health Nurse Practitioner
    • Owings Mills, MD
    • NPI 1669941175

    6800297524

    Same PAC ID

National Provider Directory

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

Other organizations with this tax ID 9

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

Locations

6401 New Hampshire Ave
Hyattsville, MD 20783
Phone (301) 801-0292

Practitioners & affiliated clinicians

Practitioners 3

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": "1632441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735516800000",
    "number": "1609547009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10220 S DOLFIELD RD STE 106",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211173660",
            "telephone_number": "443-559-4137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6401 NEW HAMPSHIRE AVE",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207833201",
            "telephone_number": "410-364-8194",
            "fax_number": "410-364-8194"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7309 Baltimore Ave Ste 219",
            "address_purpose": "LOCATION",
            "city": "College Park",
            "state": "MD",
            "postal_code": "207403200",
            "country_code": "US",
            "telephone_number": "443-559-4137",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MD MATT LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MD MATT LLC",
        "enumeration_date": "2021-09-24",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A",
        "authorized_official_last_name": "SHAFFER",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "443-220-6122"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181014604",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "062712289",
            "state": "DC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.mdmatt.com",
            "affiliation": "N",
            "endpointDescription": "website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "7309 Baltimore Ave Ste 219",
            "city": "College Park",
            "state": "MD",
            "country_code": "US",
            "postal_code": "207403200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hyattsville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 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.