Individual provider Active NPI

Thomas Anthone Taylor Matros, LPN

  • Licensed Practical Nurse
  • South St Paul, MN
National Provider Identifier
1699286443
Registry record updated Sep 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
L730901 Issued in MN
Practice address
710 19TH Ave N Ste 300
South St Paul, MN 55075-1301
Phone
(651) 471-9038
NPI assigned
Oct 19, 2017
Last updated
Sep 29, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X L730901 MN Primary

Addresses

Primary practice location

710 19TH Ave N Ste 300
South St Paul, MN 55075-1301

Mailing address

710 19TH Ave N Ste 300
South St Paul, MN 55075-1301
Phone (651) 471-9038

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
L730901MNMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1508371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1699286443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 19TH AVE N STE 300",
            "city": "SOUTH ST PAUL",
            "state": "MN",
            "postal_code": "550751301",
            "telephone_number": "651-471-9038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 19TH AVE N STE 300",
            "city": "SOUTH ST PAUL",
            "state": "MN",
            "postal_code": "550751301",
            "telephone_number": "651-471-9038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATROS",
        "first_name": "THOMAS",
        "middle_name": "ANTHONE TAYLOR",
        "name_prefix": "Mr.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-19",
        "last_updated": "2026-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MN",
            "license": "L730901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South St Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; 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.