Individual provider Active NPI

Mattie Boehler-Tatman, MD

  • Student in an Organized Health Care Education/Training Program
  • Santa Monica, CA
National Provider Identifier
1710622048
Registry record updated Aug 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1250 16TH St
Santa Monica, CA 90404-1249
Phone
(310) 825-9111
NPI assigned
May 2, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X CA Primary

Addresses

Primary practice location

1250 16TH St
Santa Monica, CA 90404-1249

Mailing address

1250 16TH St
Santa Monica, CA 90404-1249

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250514001666 CA Order and Referring Only - Obstetrics/GynecologyPractitioner - Obstetrics/Gynecology 6608394655

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1651449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785974400000",
    "number": "1710622048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 16TH ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904041249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 16TH ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904041249",
            "telephone_number": "310-825-9111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEHLER-TATMAN",
        "first_name": "MATTIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-02",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.