Active NPI
Israel Mata, M.D.
- Pediatrics Physician
- Pharr, TX
National Provider Identifier
1881693018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- J2456
- Practice address
- 105 E Polk Ave
Pharr, TX 78577-3110 - Phone
- (956) 781-6591
- Fax
- (956) 702-0185
- NPI assigned
- Jul 19, 2005
- Reactivated
- Mar 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | J2456 | TX | Primary |
Addresses
Primary practice location
105 E Polk Ave
Pharr, TX 78577-3110
Mailing address
105 E Polk Ave
Pharr, TX 78577-3110
Phone (956) 781-6591
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121107003 | Medicaid | TX | |
| 121107006 | Medicaid | TX | |
| 121107001 | Medicaid | TX |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494720000000",
"number": "1881693018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 E POLK AVE",
"city": "PHARR",
"state": "TX",
"postal_code": "785773110",
"telephone_number": "956-781-6591",
"fax_number": "956-702-0185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 E POLK AVE",
"city": "PHARR",
"state": "TX",
"postal_code": "785773110",
"telephone_number": "956-781-6591",
"fax_number": "956-702-0185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATA",
"first_name": "ISRAEL",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-19",
"last_updated": "2017-05-14",
"deactivation_date": "2006-03-20",
"reactivation_date": "2006-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "J2456",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "121107003",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "121107006",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "121107001",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pharr, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.