Individual provider Active NPI

Marta Matos, MD

  • General Practice Physician
  • San Juan, PR
National Provider Identifier
1861448748
Registry record updated Feb 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
14645 Issued in PR
Practice address
200 Ave Winston Churchill
Suite 301
San Juan, PR 00926-6651
Phone
(787) 759-8888
Fax
(787) 792-2034
NPI assigned
May 25, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 21, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 14645 PR Primary

Addresses

Primary practice location

200 Ave Winston Churchill
Suite 301
San Juan, PR 00926-6651

Mailing address

200 Ave Winston Churchill
Suite 301
San Juan, PR 00926-6651
Phone (787) 759-8888

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20040225000463 PR Practitioner - General Practice 4284520420 Practice locations: Cidra, PR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
14645PRMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grupo Medico Medicina Especializada PastSince Aug 25, 2015 Accepting new patients
Psychological Empowerment LLC Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361404800000",
    "number": "1861448748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 AVE WINSTON CHURCHILL",
            "address_2": "SUITE 301",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009266651",
            "telephone_number": "787-759-8888",
            "fax_number": "787-792-2034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 AVE WINSTON CHURCHILL",
            "address_2": "SUITE 301",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009266651",
            "telephone_number": "787-759-8888",
            "fax_number": "787-792-2034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATOS",
        "first_name": "MARTA",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2013-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "14645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.