Michelle Renea Mata, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95024337 Issued in CA

Practice address

10109 Ashdale LN
Santee, CA 92071-1635

Phone

(619) 560-3454

NPI assigned

Feb 17, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Graybill Medical Group IncGroup PAC ID 9335050517, 103 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: michelle.mata.p1@direct.arch.nextgenshare.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Graybill Medical Group Inc

  • Family Medicine Physician
  • Escondido, CA
  • NPI 1891729745
  Medicare reassignment Care Compare group NPD
• Monica Perlman MD Inc.

  • Primary Care Clinic/Center
  • La Jolla, CA
  • NPI 1134309305
  Medicare reassignment NPD

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

{
    "created_epoch": "1676592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1932807112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10109 ASHDALE LN",
            "city": "SANTEE",
            "state": "CA",
            "postal_code": "920711635",
            "telephone_number": "619-560-3454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10109 ASHDALE LN",
            "city": "SANTEE",
            "state": "CA",
            "postal_code": "920711635",
            "telephone_number": "619-560-3454"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 East Second Avenue",
            "address_purpose": "LOCATION",
            "city": "Escondido",
            "state": "CA",
            "postal_code": "92025",
            "country_code": "US",
            "telephone_number": "760-291-6700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATA",
        "first_name": "MICHELLE",
        "middle_name": "RENEA",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-17",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95024337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ofelia Martinez
• Deana Lue Martorana
• Kimberly Mason
• Rosemary Mason, PCD(DONA),CLC
• Jason Anthony Massey, PHARMD, RPH
• Froilan Felipe M. Matondo, REGISTERED NURSE
• Vanessa Rae Mauricio
• Victoria Baldwin Maushardt, AMFT
• Mays Alshawi DDS Inc
• Joel Mbemba

• Family Nurse Practitioner in Santee, CA
• Providers in Santee, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; 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.