Active NPI
Chris Matula
- Social Worker
- Menasha, WI
National Provider Identifier
1881761567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 658
- Practice address
- 1095 Midway Rd
Menasha, WI 54952-1115 - Phone
- (920) 720-2300
- NPI assigned
- Nov 29, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 658 | WI | Primary |
Addresses
Primary practice location
1095 Midway Rd
Menasha, WI 54952-1115
Mailing address
PO Box 8003
Appleton, WI 54912-8003
Phone (920) 996-3298
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39674100 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 658 | WI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thedacare, Incorporated | Current | Accepting new patients | |
| Thedacare, Incorporated | Social Worker | Current | Accepting new patients |
Locations
1095 Midway Rd
Menasha, WI 54952
Phone (920) 720-3700
3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229
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.
-
- Family Medicine Physician
- New London, WI
- NPI 1376656959
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881761567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8003",
"city": "APPLETON",
"state": "WI",
"postal_code": "549128003",
"telephone_number": "920-996-3298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1095 MIDWAY RD",
"city": "MENASHA",
"state": "WI",
"postal_code": "549521115",
"telephone_number": "920-720-2300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATULA",
"first_name": "CHRIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "WI",
"license": "658",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39674100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Menasha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.