Active NPI
Michael Jon Mattice, M.D.
- Medical Toxicology (Preventive Medicine) Physician
- Vero Beach, FL
National Provider Identifier
1821075219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Toxicology (Preventive Medicine) Physician
- License
- ME0049088
- Practice address
- 3725 10TH Court
Vero Beach, FL 32960 - Phone
- (772) 213-3621
- Fax
- (772) 213-3631
- NPI assigned
- Dec 27, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Toxicology (Preventive Medicine) Physician | 2083T0002X | ME0049088 | FL | Primary |
Addresses
Primary practice location
3725 10TH Court
Vero Beach, FL 32960
Mailing address
3725 10TH Court
Vero Beach, FL 32960
Phone (772) 213-3621
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ME0049088 | Other | FL | MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 1, 2021 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0049088 | FL | MD | Medical Toxicology (Preventive Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592352000000",
"number": "1821075219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3725 10TH COURT",
"city": "VERO BEACH",
"state": "FL",
"postal_code": "32960",
"telephone_number": "772-213-3621",
"fax_number": "772-213-3631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3725 10TH COURT",
"city": "VERO BEACH",
"state": "FL",
"postal_code": "32960",
"telephone_number": "772-213-3621",
"fax_number": "772-213-3631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTICE",
"first_name": "MICHAEL",
"middle_name": "JON",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-27",
"last_updated": "2020-06-17",
"certification_date": "2020-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "2083T0002X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Medical Toxicology",
"state": "FL",
"license": "ME0049088",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "ME0049088",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vero Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.