Matilda Otang Eyong Epse Ebaietaka, PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Gilbert, AZ
NPI 1952159253 · NPPES record last updated May 10, 2024
Key facts
- NPI
- 1952159253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 223835 (AZ)
- Practice address
- 3755 S Rome Street
Gilbert, AZ 85297 - Phone
- (480) 677-5500
- NPI assigned
- May 10, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 15
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Pinal Hispanic Council
Practice addresses (Care Compare)
107 E 4TH St
Eloy, AZ 85131-2506
Phone (520) 466-7765
556 S Arizona Blvd
Coolidge, AZ 85128-5106
Phone (520) 723-7405
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250722004052 | AZ | Practitioner - Nurse Practitioner | 8729594114 | Reassigns benefits to 6 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 223835 | AZ | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Intermountain Health Center, Inc. | Current |
Accepting new patients | |
| Community Partners Integrated Healthcare, Inc. | Current |
Accepting new patients | |
| Intermountain Health Center Inc | Current |
Accepting new patients | |
| Pinal Hispanic Council Incorporated | Current |
Accepting new patients | |
| Community Partners Integrated Healthcare Inc. | Current |
Accepting new patients | |
| Family Service Agency | Current |
Accepting new patients | |
| Community Partners Integrated Healthcare, Inc. | Current | Accepting new patients | |
| Fulton & Fulton LLC | Current |
Accepting new patients | |
| Mental Health Resources Inc | Past | Accepting new patients | |
| Intermountain Centers for Human Development Inc. | Past | Accepting new patients | |
| Intermountain Centers for Human Development | Past | Accepting new patients | |
| Behavioral Consultation Services, Inc. | Past | Accepting new patients |
Locations
500 S Highway 80
Ste A
Benson, AZ 85602
Phone (520) 720-0290
1326 W Highway 92
Ste J
Bisbee, AZ 85603
Phone (520) 366-3603
2028 N Trekell Rd
Ste 102
Casa Grande, AZ 85122
Phone (520) 381-3010
1667 N Trekell Rd
Ste 101
Casa Grande, AZ 85122
Phone (520) 284-5436
556 S Arizona Blvd
Coolidge, AZ 85128
Phone (520) 723-7405
1930 E 11th St
Douglas, AZ 85607
Phone (520) 364-4508
1107 S Gilbert Rd
Ste 104
Mesa, AZ 85204
Phone (602) 264-9891
3707 E Southern Ave
Mesa, AZ 85206
Phone (480) 327-9103
560 W Brown Rd
Ste 1011
Mesa, AZ 85201
Phone (480) 235-7327
272 W View Point Dr
Nogales, AZ 85621
Phone (520) 281-0678
1515 E Osborn Rd
Phoenix, AZ 85014
Phone (602) 604-0000
4337 W Indian School Rd
Ste 109110
Phoenix, AZ 85031
Phone (602) 233-9401
301 E 4th St
Ste A
Safford, AZ 85546
Phone (928) 792-4242
994 S Harrison Rd
Tucson, AZ 85748
Phone (520) 539-5091
5055 E Broadway Blvd
Ste C104
Tucson, AZ 85711
Phone (520) 623-9833
1773 W Saint Marys Rd
Ste 105
Tucson, AZ 85745
Phone (520) 622-8357
1021 E Palmdale St
Ste 150190
Tucson, AZ 85714
Phone (520) 333-4320
5055 E Broadway Blvd
Ste A200
Tucson, AZ 85711
Phone (520) 901-4701
2499 E Ajo Way
Tucson, AZ 85713
Phone (520) 618-8700
2545 S Arizona Ave
Bldg A
Yuma, AZ 85364
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 223835 | AZ | Yes |
Addresses
Primary practice location
3755 S Rome Street
Gilbert, AZ 85297
Mailing address
6945 S Opal Dr
Chandler, AZ 85249-7221
Phone (480) 452-6424
Other providers in Gilbert, AZ
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- Expressive Regulation Creative Therapy
- Eye Care Clinic P.C.
- Eyedeology Vision Center PLLC
- Eyes Eyes Baby PLLC
- Veronica Ezop
- Mark Gregory Faber
- Sean Faby
- Mitchell Lee Factor
- Layla Fahrbach
All providers in Gilbert, AZ · Psychiatric/Mental Health Nurse Practitioner in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.