Nina Louise Mattarella, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD185106 Issued in OR

Practice address

2870 NE West Devils Lake Rd
Lincoln City, OR 97367-5127

Phone

(541) 994-9191

Fax

(541) 994-9034

NPI assigned

Sep 28, 2006

Last updated

Nov 4, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nmattarella145526@samhealth.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northwest Medical Foundation of Tillamook

  dba Adventist Health Tillamook

  • Critical Access Hospital
  • Tillamook, OR
  • NPI 1871575225
  Medicare reassignment NPD
• Northwest Medical Foundation of Tillamook

  dba Adventist Health Medical Office - Sheridan

  • Critical Access Hospital
  • Sheridan, OR
  • NPI 1053873919
  NPD

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1881786119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1194",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2870 NE WEST DEVILS LAKE RD",
            "city": "LINCOLN CITY",
            "state": "OR",
            "postal_code": "973675127",
            "telephone_number": "541-994-9191",
            "fax_number": "541-994-9034"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 E Michigan Ave Ste 145",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "48912",
            "country_code": "US",
            "telephone_number": "517-364-5440",
            "fax_number": "517-364-5409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTARELLA",
        "first_name": "NINA",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301054688",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD185106",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MI",
            "license": "4301054688",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881786119",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4796017",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS INDIVIDUAL PIN",
            "identifier": "3503334051",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nmattarella145526@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "2870 NE West Devils Lake Rd",
            "city": "Lincoln City",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973675127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rejeesh Menon Manchezhathu Rajagopalamenon, MD
• Meredith T Mann, DO
• Margaret a Portwood (Coastal Health Practitioners)
• Jane Beth Margulis, M.S., MFC
• Dianne T Mason, LCSW
• Robin Mays, RPH
• Brenda McAllister, RN
• Christine Lynn McCambridge, PMHNP-BC
• Caitlyn McCoy, DO
• Jeffrey H McDonald, MD

• Pediatrics Physician in Lincoln City, OR
• Providers in Lincoln City, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; 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.

Verify at the official NPI Registry.