Active NPI
Mattie Vincentnetta Street, PATIENT CARE ASSOCIA
- Home Health Agency
- Columbus, OH
National Provider Identifier
1730731597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Practice address
- 762 Conestoga Dr
Columbus, OH 43213-2616 - Phone
- (614) 272-4009
- NPI assigned
- Jul 11, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | CHW.001230 | OH | |
| Home Health Agency | 251E00000X | Primary |
Addresses
Primary practice location
762 Conestoga Dr
Columbus, OH 43213-2616
Mailing address
1773 Lattimer Dr
Columbus, OH 43227-2567
Phone (614) 604-2435
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
| License | State | Type | Specialty |
|---|---|---|---|
| CHW.001230 | OH | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562803200000",
"number": "1730731597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1773 LATTIMER DR",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432272567",
"telephone_number": "614-604-2435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "762 CONESTOGA DR",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432132616",
"telephone_number": "614-272-4009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STREET",
"first_name": "MATTIE",
"middle_name": "VINCENTNETTA",
"name_prefix": "Mrs.",
"credential": "PATIENT CARE ASSOCIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-07-11",
"last_updated": "2019-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OH",
"license": "CHW.001230",
"primary": false
},
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.