Yesu Matta, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

64545 Issued in CT

Practice address

675 Main Street
Middletown, CT 06457-0645

Phone

(860) 347-6971

NPI assigned

Aug 14, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: yesu.matta@chcict.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Middletown, CT
  • NPI 1952591851

  Pediatrics

  Medicare reassignment NPD
• Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Danbury, CT
  • NPI 1003332446
  NPD
• Community Health Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Middletown, CT
  • NPI 1164463840

  Pediatrics

  NPD (past)
• Chenango Memorial Hospital, Inc.

  • Family Medicine Physician
  • Norwich, NY
  • NPI 1467526889

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1344902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579651200000",
    "number": "1851648471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 LENOX AVE # MLK17110",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100371802",
            "telephone_number": "212-939-4019",
            "fax_number": "212-939-4022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 MAIN STREET",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064570645",
            "telephone_number": "860-347-6971"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "506 Lenox Ave # Mlk17110",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100371802",
            "country_code": "US",
            "telephone_number": "212-939-4019",
            "fax_number": "212-939-4022",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTA",
        "first_name": "YESU",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-14",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "64545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Massage for the Soul LLC
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• Rosetta S Masson
• Dawn Victoria Masterson, LPCA, LMT
• Jalitza Mathews
• Lauren Matteau, LCSW
• Shirley Mattfeld, LCSW
• Matthew Raider MD LLC
• Katelyn Matuska, LCSW
• Aura Matyjas, PHARMD

• Pediatrics Physician in Middletown, CT
• Providers in Middletown, CT by specialty
• Pediatrics Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.