Matilda Otang Eyong Epse Ebaietaka, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

223835 Issued in AZ

Practice address

3755 S Rome Street
Gilbert, AZ 85297

Phone

(480) 677-5500

NPI assigned

May 10, 2024

Last updated

May 10, 2024By the provider in NPPES

Sex

Male

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 AZ

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, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Pinal Hispanic CouncilGroup PAC ID 4981742434, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pinal Hispanic Council

  • Multi-Specialty Clinic/Center
  • Eloy, AZ
  • NPI 1235271404
  Medicare reassignment Care Compare group
• Fulton & Fulton LLC

  dba Mesquite Valley Integrated Health

  • Community Health Nurse Practitioner
  • Mesa, AZ
  • NPI 1790384014
  Medicare reassignment NPD
• Intermountain Health Center Inc

  • Multi-Specialty Clinic/Center
  • Tucson, AZ
  • NPI 1609245273
  Medicare reassignment NPD
• Community Partners Integrated Healthcare, Inc.

  • Multi-Specialty Clinic/Center
  • Tucson, AZ
  • NPI 1669897385
  Medicare reassignment
• Intermountain Centers for Human Development Inc.

  • Community/Behavioral Health Agency
  • Tucson, AZ
  • NPI 1083846661
  Medicare reassignment
• Community Partners Integrated Healthcare Inc.

  • Multi-Specialty Clinic/Center
  • Tucson, AZ
  • NPI 1558020503
  NPD
• Community Partners Integrated Healthcare, Inc.

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1346620358
  NPD
• Community Partners Integrated Healthcare, Inc.

  • Multi-Specialty Clinic/Center
  • Yuma, AZ
  • NPI 1457459091
  NPD
• Family Service Agency

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1255538732
  NPD
• Intermountain Health Center, Inc.

  • Community/Behavioral Health Agency
  • Casa Grande, AZ
  • NPI 1083315626
  NPD
• Pinal Hispanic Council Incorporated

  • Multi-Specialty Clinic/Center
  • Coolidge, AZ
  • NPI 1194521914
  NPD
• Behavioral Consultation Services, Inc.

  • Community/Behavioral Health Agency
  • Flagstaff, AZ
  • NPI 1629432380
  NPD (past)

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

{
    "created_epoch": "1715299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1952159253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6945 S OPAL DR",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852497221",
            "telephone_number": "480-452-6424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3755 S ROME STREET",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85297",
            "telephone_number": "480-677-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EYONG EPSE EBAIETAKA",
        "first_name": "MATILDA",
        "middle_name": "OTANG",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-10",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "223835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mark Gregory Faber, DO
• Sean Faby, PT
• Mitchell Lee Factor, M.D.
• Layla Fahrbach

• Psychiatric/Mental Health Nurse Practitioner in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; 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.