Individual provider Active NPI

Simona Mattarelliano, NP

  • Pediatric Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1679915326
Registry record updated Dec 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
F382327 Issued in NY
Practice address
948 48TH St
Brooklyn, NY 11219-2918
Phone
(718) 283-7500
NPI assigned
Jul 23, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X F382327 NY Primary

Addresses

Primary practice location

948 48TH St
Brooklyn, NY 11219-2918

Mailing address

948 48TH St
Brooklyn, NY 11219-2918
Phone (718) 283-7500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190815002928 NY Practitioner - Nurse Practitioner 9739416546 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MMC Pediatrics Faculty PracticeGroup PAC ID 0143406918, 3 clinicians

Practice addresses (Care Compare)

4802 10TH Ave
Brooklyn, NY 11219-2916
Phone (718) 283-7501

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F382327NYMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Maimonides Medical Center Current Accepting new patients
MMC Pediatrics Faculty Practice CurrentSince Jul 1, 2022 Accepting new patients
Maimonides Faculty Practice Plan CurrentSince Jul 3, 2019 Accepting new patients

Locations

948 48th St
Brooklyn, NY 11219
Phone (718) 283-7219

6010 Bay Pkwy
Ste 9
Brooklyn, NY 11204
Phone (718) 283-7500

4802 10th Ave
Brooklyn, NY 11219
Phone (718) 283-8724

6010 Bay Pkwy
#9
Brooklyn, NY 11204

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: simonamattarelliano@mai.allscriptsdirect.net
  • Direct secure messaging: simona.mattarelliano.p1@direct.mmc.nextgenshare.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417564800000",
    "number": "1679915326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "948 48TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112192918",
            "telephone_number": "718-283-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "948 48TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112192918",
            "telephone_number": "718-283-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTARELLIANO",
        "first_name": "SIMONA",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-23",
        "last_updated": "2014-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "F382327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.