Individual provider Active NPI

Jannett Matusiak, MT

  • Specialist
  • Portland, ME
National Provider Identifier
1871535146
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MT1529 Issued in ME
Practice address
222 Saint John St
Suite 214
Portland, ME 04102-3000
Phone
(207) 871-7657
NPI assigned
Jun 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MT1529 ME Primary

Addresses

Primary practice location

222 Saint John St
Suite 214
Portland, ME 04102-3000

Mailing address

222 Saint John St
Suite 214
Portland, ME 04102-3000
Phone (207) 871-7657

Other identifiers 1

IdentifierTypeStateIssuer
048210OtherMEBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Medical Technician

State licenses

LicenseStateTypeSpecialty
MT1529MEMDSpecialist

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1871535146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 SAINT JOHN ST",
            "address_2": "SUITE 214",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023000",
            "telephone_number": "207-871-7657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 SAINT JOHN ST",
            "address_2": "SUITE 214",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023000",
            "telephone_number": "207-871-7657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATUSIAK",
        "first_name": "JANNETT",
        "credential": "MT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ME",
            "license": "MT1529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "048210",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.