Jacob Nathaniel Mattox, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

125.075832 Issued in IL

Practice address

4440 W 95TH St
Oak Lawn, IL 60453-2600

Phone

(708) 684-8000

NPI assigned

Mar 27, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IN, TX2 enrollments

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 2

Specialty

Emergency Medicine

Education

University of Southern California Keck School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clarksville Emergency Group PCGroup PAC ID 6507277423, 149 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Franciscan Health Michigan City Hospital, Michigan City, IN, CCN 150015
• Red Lake Hospital Hospital, Redlake, MN, CCN 240206

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Clarksville Emergency Group, PC

  • Emergency Medicine Physician
  • Corydon, IN
  • NPI 1023487154
  Medicare reassignment Care Compare group NPD
• Clarksville Physician Services PC

  • Internal Medicine Physician
  • Corydon, IN
  • NPI 1811629546
  Medicare reassignment NPD
• PHS Indian Hospital

  • General Acute Care Hospital
  • Red Lake, MN
  • NPI 1508809765

  TX

  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Franciscan Health Michigan City

  • General Acute Care Hospital
  • La Porte, IN
  • NPI 1679336747
  Care Compare affiliation
• Franciscan Health Michigan City

  • General Acute Care Hospital
  • Michigan City, IN
  • NPI 1710051941
  Care Compare affiliation

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

{
    "created_epoch": "1585267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592352000000",
    "number": "1922636893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4440 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532600",
            "telephone_number": "708-684-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4440 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532600",
            "telephone_number": "708-684-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTOX",
        "first_name": "JACOB",
        "middle_name": "NATHANIEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-27",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125.075832",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "125.075832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Don Mathew
• Travis Jordan Matics, D.O.
• Brandee Leigh Mattera
• Michelle Denise Matthews
• Re'Jahnique Chicana Matthews, DNP, APRN, CPNP-PC
• Natalia Monika Matula
• Joanna M. Maurice, M.D.
• Mohamad Al Mawaldi, MD
• Esmael Mayar, MD
• Emily Meredith Mayekar, M.D.

• Emergency Medicine Physician in Oak Lawn, IL
• Providers in Oak Lawn, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.
• 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.