Active NPI
Kaavya Reddy Matatova, MD
- Surgery Physician
- Phoenix, AZ
National Provider Identifier
1649413089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 52218
- Practice address
- 19646 N 27TH Ave Ste 201
Phoenix, AZ 85027-4026 - Phone
- (602) 663-9371
- Fax
- (602) 456-6887
- NPI assigned
- Apr 15, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD.206827 | LA | |
| Surgery Physician | 208600000X | 52218 | AZ | Primary |
Addresses
Primary practice location
19646 N 27TH Ave Ste 201
Phoenix, AZ 85027-4026
Mailing address
19646 N 27TH Ave Ste 201
Phoenix, AZ 85027-4026
Phone (602) 663-9371
Other names 1
- Kaavya Reddy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD.206827 | LA | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Privia Medical Group Arizona, LLC | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Payson, AZ
- NPI 1740459700
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583280000000",
"number": "1649413089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19646 N 27TH AVE STE 201",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850274026",
"telephone_number": "602-663-9371",
"fax_number": "602-456-6887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19646 N 27TH AVE STE 201",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850274026",
"telephone_number": "602-663-9371",
"fax_number": "602-456-6887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATATOVA",
"first_name": "KAAVYA",
"middle_name": "REDDY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-04-15",
"last_updated": "2020-03-04",
"certification_date": "2020-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "LA",
"license": "MD.206827",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "AZ",
"license": "52218",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KAAVYA",
"last_name": "REDDY",
"credential": "MD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.