NPIMap

Organization Active NPI

MD Matt LLC

  • Family Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1861033441
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
MD MATT LLC
Practice address
1050 North Point Rd
Baltimore, MD 21224-3329
Phone
(410) 575-1785
NPI assigned
Oct 4, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Authorized official

Name
William Shaffer
Title
Care Coordinator
Phone
(443) 559-4137

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

1050 North Point Rd
Baltimore, MD 21224-3329

Mailing address

225 S Castle St
Baltimore, MD 21231-2602

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210701000406 MD Part B Supplier - Clinic/Group Practice 6800297524 Receives reassigned benefits from 11 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Frederick, MD; Owings Mills, MD; Linthicum Heights, MD; Hagerstown, MD; Baltimore, MD

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
MD Matt LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

9533 Belair Rd
Nottingham, MD 21236

Practitioners & affiliated clinicians

Practitioners 1

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": "1570147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643673600000",
    "number": "1861033441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 S CASTLE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212312602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 NORTH POINT RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212243329",
            "telephone_number": "410-575-1785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD MATT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-04",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A",
        "authorized_official_last_name": "SHAFFER",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CARE COORDINATOR",
        "authorized_official_telephone_number": "443-559-4137"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; 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.