Matta Medical Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MATTA MEDICAL CLINIC LLC

Practice address

647 Bienville Cir
Natchitoches, LA 71457-5744

Phone

(318) 238-5990

NPI assigned

Aug 16, 2018

Last updated

Aug 16, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Sujatha Gubbala, MDNPI 1164818894

Title

Manager

Phone

(318) 238-5990

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sujatha Gubbala, MD

  • Family Medicine Physician
  • Natchitoches, LA
  • NPI 1164818894

  Single Specialty

  Medicare reassignment Care Compare group NPD Authorized official
• Anil Matta, M.D.

  • Hospitalist Physician
  • Natchitoches, LA
  • NPI 1871795674

  Family Medicine

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1534377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534377600000",
    "number": "1881174027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7111",
            "city": "NATCHITOCHES",
            "state": "LA",
            "postal_code": "714570111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "647 BIENVILLE CIR",
            "city": "NATCHITOCHES",
            "state": "LA",
            "postal_code": "714575744",
            "telephone_number": "318-238-5990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTA MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-16",
        "last_updated": "2018-08-16",
        "status": "A",
        "authorized_official_last_name": "GUBBALA",
        "authorized_official_first_name": "SUJATHA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "318-238-5990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2387766",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeremy Martin
• Rolanda Martin
• Shelby Lynne Martin, LPC
• Mary Ingram Long a Professional Medical Corporation (Mary I Long)
• Phyllis Lynnette Mason, M.D.
• Anil Matta, M.D.
• Latwana Matthew
• Shecola Dion Matthews
• Maxx Medical Corporation
• Christopher A Mayeux, RPH

• Family Medicine Physician in Natchitoches, LA
• Providers in Natchitoches, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2018; 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.