NPIMap

Organization Active NPI

MD Matt LLC

  • Adult Health Nurse Practitioner
  • Frederick, MD
National Provider Identifier
1619583200
Registry record updated Jul 16, 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
309 E Patrick St
Frederick, MD 21701-6792
Phone
(240) 292-1088
NPI assigned
Sep 18, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 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

309 E Patrick St
Frederick, MD 21701-6792

Mailing address

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

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.mdmatt.com

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

1050 Northpoint Rd
Ste 203
Baltimore, MD 21224
Phone (443) 559-4137

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

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1600387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721088000000",
    "number": "1619583200",
    "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": "309 E PATRICK ST",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217016792",
            "telephone_number": "240-292-1088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD MATT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-18",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "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": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.mdmatt.com",
            "affiliation": "N",
            "address_1": "309 E Patrick St",
            "city": "Frederick",
            "state": "MD",
            "country_code": "US",
            "postal_code": "217016792",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.