Jill Marie Mattern

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

14753 Issued in CA

Practice address

201 Brush St
Ukiah, CA 95482-3424

Phone

(707) 462-6290

Fax

(707) 468-6427

NPI assigned

Feb 12, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DGCECD
• FHIR API: https://api.platform.athenahealth.com/5949/brand/1/csg/1/fhir/r4

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.

• Ford Street Project

  • Substance Abuse Rehabilitation Facility
  • Ukiah, CA
  • NPI 1073946547
  NPD (past)
• Amboy Medical Practice PC

  • Diagnostic Radiology Physician
  • Staten Island, NY
  • NPI 1104692672
  NPD (past)
• Amboy Medical Practice PC

  • Internal Medicine Physician
  • Staten Island, NY
  • NPI 1700037975

  Obstetrics & Gynecology

  NPD (past)
• Cornerstone Family Healthcare

  • Federally Qualified Health Center (FQHC)
  • Newburgh, NY
  • NPI 1114757515
  NPD (past)
• David M Herzog MD PC

  • Gynecologic Oncology Physician
  • Staten Island, NY
  • NPI 1033225370
  NPD (past)

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675900800000",
    "number": "1669514253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 BRUSH ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954823424",
            "telephone_number": "707-462-6290",
            "fax_number": "707-468-6427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 BRUSH ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954823424",
            "telephone_number": "707-462-6290",
            "fax_number": "707-468-6427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTERN",
        "first_name": "JILL",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A78277",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "242578-1",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "14753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Mathias
• John Mathis
• Anu Mathur, LMFT, ATR-BC
• Harry Berj Matossian, M.D.
• Courtney Anne Matson, CNM
• Matthew Jeffers DDS
• Donna Lee Matthews
• Amy Mattiuzzo
• Martha S Mazur-Lane, PHARM D.
• Marlene H McBride, DNP

• Addiction (Substance Use Disorder) Counselor in Ukiah, CA
• Providers in Ukiah, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.