NPIMap

Organization Active NPI

Mavis N Matsumoto, MD, LLC

  • Primary Care Clinic/Center
  • Henderson, NV
National Provider Identifier
1932497229
Registry record updated Apr 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
7825 Issued in NV
Legal business name
MAVIS N MATSUMOTO, MD, LLC
Practice address
870 Seven Hills Dr
Suite 102
Henderson, NV 89052-4377
Phone
(702) 992-4050
Fax
(702) 992-4052
NPI assigned
Jul 20, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2012

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

Authorized official

Name
Dr. Mavis N 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
Primary Care Clinic/Center 261QP2300X 7825 NV Primary

Addresses

Primary practice location

870 Seven Hills Dr
Suite 102
Henderson, NV 89052-4377

Mailing address

870 Seven Hills Dr
Suite 102
Henderson, NV 89052-4377
Phone (702) 992-4050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110804000272 NV Part B Supplier - Clinic/Group Practice 6800065012 Receives reassigned benefits from 2 practitioners
Practice locations: Henderson, NV

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

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": "1311120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334275200000",
    "number": "1932497229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 SEVEN HILLS DR",
            "address_2": "SUITE 102",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890524377",
            "telephone_number": "702-992-4050",
            "fax_number": "702-992-4052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 SEVEN HILLS DR",
            "address_2": "SUITE 102",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890524377",
            "telephone_number": "702-992-4050",
            "fax_number": "702-992-4052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAVIS N MATSUMOTO, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-20",
        "last_updated": "2012-04-13",
        "status": "A",
        "authorized_official_last_name": "MATSUMOTO",
        "authorized_official_first_name": "MAVIS",
        "authorized_official_middle_name": "N",
        "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": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NV",
            "license": "7825",
            "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 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.