NPIMap

Individual provider Active NPI

Mark A. Mataosky, M.D.

  • Cardiovascular Disease Physician
  • Ladson, SC
National Provider Identifier
1699720821
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
26990 Issued in SC
Practice address
3601 Ladson Rd Ste 100
Ladson, SC 29456-4304
Phone
(843) 797-7700
Fax
(843) 797-1271
NPI assigned
May 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 26990 SC Primary

Addresses

Primary practice location

3601 Ladson Rd Ste 100
Ladson, SC 29456-4304

Mailing address

3601 Ladson Rd Ste 100
Ladson, SC 29456-4304
Phone (843) 285-2500

Other identifiers 2

IdentifierTypeStateIssuer
PA4833MedicaidSC
26990OtherSCLICENSE #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041101000190 SC Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 6608838842 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Georgetown University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

171 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-1414

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Palmetto Primary Care Physicians, LLC Current Accepting new patients
Palmetto Primary Care Physicians, LLC CurrentSince Feb 15, 2019 Accepting new patients
University Medical Associates of the Medical University of South Carol Cardiovascular Disease Current Accepting new patients
Trident Cardiology Associates, PA Cardiovascular Disease CurrentSince Apr 1, 2018 Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Jul 1, 2024 Accepting new patients
Palmetto Primary Care Physicians, LLC CurrentSince Feb 15, 2019 Accepting new patients

Locations

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

3601 Ladson Rd
Ste 100
Ladson, SC 29456
Phone (843) 285-2500

2550 Elms Center Rd
North Charleston, SC 29406
Phone (843) 302-8840

100 Guild St
Ste 101
Summerville, SC 29486

Interoperability endpoints

  • Direct secure messaging: mmataosky501131@direct.musc.edu
  • FHIR API: https://api.platform.athenahealth.com/13532/brand/1/csg/1/fhir/r4

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1699720821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 LADSON RD STE 100",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "294564304",
            "telephone_number": "843-285-2500",
            "fax_number": "843-285-2505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 LADSON RD STE 100",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "294564304",
            "telephone_number": "843-797-7700",
            "fax_number": "843-797-1271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATAOSKY",
        "first_name": "MARK",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "SC",
            "license": "26990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA4833",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "26990",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ladson, SC

Sources for this page

Verify at the official NPI Registry.