Tina M Mattera, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

036099511 Issued in IL

Practice address

5950 Lincoln Ave
Unit W
Lisle, IL 60532-3104

Phone

(630) 541-8930

Fax

(630) 541-8940

NPI assigned

Apr 13, 2007

Last updated

Sep 29, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Wellspring Clinical Associates, Inc.

  • Psychiatry Physician
  • Lisle, IL
  • NPI 1164562609
  NPD (past)

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254182400000",
    "number": "1952526345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5950 LINCOLN AVE",
            "address_2": "UNIT W",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323104",
            "telephone_number": "630-541-8930",
            "fax_number": "630-541-8940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5950 LINCOLN AVE",
            "address_2": "UNIT W",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323104",
            "telephone_number": "630-541-8930",
            "fax_number": "630-541-8940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTERA",
        "first_name": "TINA",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-13",
        "last_updated": "2009-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036099511",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IL",
            "license": "036099511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martine Nelson, MD, LLC
• Philip Martinez, LCPC
• Madilyn Martus
• Ambareen Masood
• Sarah Masri, PA-C, CAQ PSYCHIATRY
• Holly Anne Mattingly, LCPC
• Daniel Matundan
• May Homemaker Services,. Inc
• John D Mazzarella, D.P.M.
• Jovonda McCall

• Child & Adolescent Psychiatry Physician in Lisle, IL
• Providers in Lisle, IL by specialty
• Child & Adolescent Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2009; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.