NPIMap

Organization Active NPI

MD Matt LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Owings Mills, MD
National Provider Identifier
1669941175
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
MD MATT LLC
Practice address
10220 S Dolfield Rd Ste 106
Owings Mills, MD 21117-3660
Phone
(443) 559-4137
NPI assigned
Nov 14, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

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

Authorized official

Name
William Cory Shaffer
Title
Care Coordinator
Phone
(443) 559-4137

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

10220 S Dolfield Rd Ste 106
Owings Mills, MD 21117-3660

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
181014600MedicaidMD

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
Practice locations: Frederick, MD; Owings Mills, MD; Linthicum Heights, MD; Hagerstown, MD; Baltimore, 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
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Hyattsville, MD
    • NPI 1609547009

    6800297524

    Same PAC ID

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

309 E Patrick St
Frederick, MD 21701
Phone (240) 310-9962

110 Painters Mill Rd
Owings Mills, MD 21117
Phone (410) 657-7952

110 Painters Mill Rd
Ste 203
Owings Mills, MD 21117
Phone (484) 201-6905

Practitioners & affiliated clinicians

Practitioners 11

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": "1542153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719187200000",
    "number": "1669941175",
    "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": "10220 S DOLFIELD RD STE 106",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211173660",
            "telephone_number": "443-559-4137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD MATT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-14",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A",
        "authorized_official_last_name": "SHAFFER",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "CORY",
        "authorized_official_title_or_position": "CARE COORDINATOR",
        "authorized_official_telephone_number": "443-559-4137"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181014600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Owings Mills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.