Individual provider Active NPI

Joseph Boyd Mutter, H.A.S.

  • Hearing Instrument Specialist
  • Port St Lucie, FL
National Provider Identifier
1699934216
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hearing Instrument SpecialistTaxonomy code 237700000X
License
AS3398 Issued in FL
Practice address
1420 SW Saint Lucie West Blvd Ste 101
Port St Lucie, FL 34986-1709
Phone
(772) 871-1222
Fax
(772) 873-4999
NPI assigned
Jun 9, 2008
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hearing Instrument Specialist 237700000X AS3398 FL Primary

Addresses

Primary practice location

1420 SW Saint Lucie West Blvd Ste 101
Port St Lucie, FL 34986-1709

Mailing address

1420 SW Saint Lucie West Blvd Ste 101
Port St Lucie, FL 34986-1709
Phone (772) 871-1222

Other identifiers 1

IdentifierTypeStateIssuer
610205100MedicaidFL

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
AS3398FLMDHearing Instrument Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Northland Hearing Centers, Inc. CurrentSince Oct 1, 2022 Accepting new patients
Northland Hearing Centers, Inc. PastSince Jul 24, 2022 Accepting new patients

Locations

1420 SW Saint Lucie West Blvd
Ste 101
Port St Lucie, FL 34986
Phone (772) 871-1222

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1699934216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 SW SAINT LUCIE WEST BLVD STE 101",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861709",
            "telephone_number": "772-871-1222",
            "fax_number": "772-873-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 SW SAINT LUCIE WEST BLVD STE 101",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861709",
            "telephone_number": "772-871-1222",
            "fax_number": "772-873-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUTTER",
        "first_name": "JOSEPH",
        "middle_name": "BOYD",
        "name_prefix": "Mr.",
        "credential": "H.A.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-09",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "FL",
            "license": "AS3398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "610205100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.