NPIMap

Organization Active NPI

Matobi Family Healthcare,LLC

  • Primary Care Clinic/Center
  • Laurel, MD
National Provider Identifier
1831750546
Registry record updated Jun 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
MATOBI FAMILY HEALTHCARE,LLC
Practice address
7350 Van Dusen Rd Ste 340
Laurel, MD 20707-5264
Phone
(240) 423-2043
NPI assigned
Jun 24, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2019

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

Authorized official

Name
Sussan Ononaku, NURSE PRACTITIONERNPI 1982029203
Title
CRNP
Phone
(240) 423-2043

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

7350 Van Dusen Rd Ste 340
Laurel, MD 20707-5264

Mailing address

12203 Loch Lynn CT
Laurel, MD 20708-2409
Phone (240) 423-2043

Other practice location 1

12203 Loch Lynn Ct
Laurel, MD 20708-2409
Phone (240) 423-2043

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191003003378 MD Part B Supplier - Clinic/Group Practice 8628309762 Receives reassigned benefits from 1 practitioner
Practice locations: Laurel, MD
O20220330001879 DC Part B Supplier - Clinic/Group Practice 8628309762 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Laurel, MD

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Matobi Family Healthcare LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561334400000",
    "number": "1831750546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12203 LOCH LYNN CT",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207082409",
            "telephone_number": "240-423-2043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7350 VAN DUSEN RD STE 340",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207075264",
            "telephone_number": "240-423-2043"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12203 Loch Lynn Ct",
            "address_purpose": "LOCATION",
            "city": "Laurel",
            "state": "MD",
            "postal_code": "207082409",
            "country_code": "US",
            "telephone_number": "240-423-2043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MATOBI FAMILY HEALTHCARE,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-24",
        "last_updated": "2019-06-24",
        "status": "A",
        "authorized_official_last_name": "ONONAKU",
        "authorized_official_first_name": "SUSSAN",
        "authorized_official_title_or_position": "CRNP",
        "authorized_official_telephone_number": "240-423-2043",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.