NPIMap

Organization Active NPI

Mavis N Matsumoto, MD, LLC

  • Non-Pharmacy Dispensing Site
  • Henderson, NV
National Provider Identifier
1902174741
Registry record updated Apr 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
MAVIS N MATSUMOTO, MD, LLC
Practice address
2780 W Horizon Ridge Pkwy
Suite 30
Henderson, NV 89052-3995
Phone
(702) 992-4050
NPI assigned
Dec 8, 2011
Organization subpart
Yes
Parent organization
MAVIS N MATSUMOTO, MD, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 15, 2013

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

Authorized official

Name
Dr. Mavis Matsumoto, M.D.NPI 1942213558
Title
Owner
Phone
(702) 992-4050

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

2780 W Horizon Ridge Pkwy
Suite 30
Henderson, NV 89052-3995

Mailing address

2980 N Beverly Glen Cir
Suite 301
Los Angeles, CA 90077-1726
Phone (310) 474-9809

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D1010709Mavis N Matsumoto, MD, LLC2780 Horizon Ridge Pkwy Ste 30, Henderson, NV 89052Certificate of waiverMar 20, 2027

National Provider Directory

National Provider Directory
Part of
Mavis N Matsumoto MD

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/13310/brand/1/csg/1/fhir/r4

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1323302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365984000000",
    "number": "1902174741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 N BEVERLY GLEN CIR",
            "address_2": "SUITE 301",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900771726",
            "telephone_number": "310-474-9809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2780 W HORIZON RIDGE PKWY",
            "address_2": "SUITE 30",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890523995",
            "telephone_number": "702-992-4050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAVIS N MATSUMOTO, MD, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAVIS N MATSUMOTO, MD, LLC",
        "enumeration_date": "2011-12-08",
        "last_updated": "2013-04-15",
        "status": "A",
        "authorized_official_last_name": "MATSUMOTO",
        "authorized_official_first_name": "MAVIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-992-4050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.