NPIMap

Organization Active NPI

Chymiymattymd LLC

Doing business as Pacifica Medicine and Wellness

  • Family Medicine Physician
  • Poulsbo, WA
National Provider Identifier
1982073235
Registry record updated Jul 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00041619 Issued in WA
Legal business name
CHYMIYMATTYMD LLC
Doing business as
Pacifica Medicine and Wellness
Practice address
19036 Front St NE # 100
Poulsbo, WA 98370-7354
Phone
(360) 979-0569
NPI assigned
Sep 16, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2024

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

Authorized official

Name
Dr. Marie Elaine Matty, M.D.NPI 1740224880
Title
President
Phone
(360) 979-0569

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X MD00041619 WA Primary

Addresses

Primary practice location

19036 Front St NE # 100
Poulsbo, WA 98370-7354

Mailing address

PO Box 2940
Poulsbo, WA 98370-2940
Phone (360) 979-0569

Other practice location 1

1173 Madison Ave N
Bainbridge Island, WA 98110-1782
Phone (360) 979-0569

Other names 1

  • Pacifica Medicine and Wellness Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151231001794 WA Part B Supplier - Clinic/Group Practice 9133421597 Receives reassigned benefits from 9 practitioners
Practice locations: Bainbridge Island, WA; Poulsbo, WA

National Provider Directory

National Provider Directory
Tax ID family
Chymiymattymd LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1173 Madison Ave N
Bainbridge Island, WA 98110
Phone (206) 842-6604

19036 Front St NE
Ste 100
Poulsbo, WA 98370
Phone (360) 979-0569

19980 10th Ave NE
Ste 202
Poulsbo, WA 98370
Phone (360) 979-0569

19980 10th Ave NE
Ste 201
Poulsbo, WA 98370
Phone (360) 598-1538

19980 10th Ave NE
Poulsbo, WA 98370
Phone (360) 564-9585

19036 Front St NE
Poulsbo, WA 98370

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1442361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722038400000",
    "number": "1982073235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2940",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983702940",
            "telephone_number": "360-979-0569",
            "fax_number": "877-805-9505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19036 FRONT ST NE # 100",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983707354",
            "telephone_number": "360-979-0569"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1173 Madison Ave N",
            "address_purpose": "LOCATION",
            "city": "Bainbridge Island",
            "state": "WA",
            "postal_code": "981101782",
            "country_code": "US",
            "telephone_number": "360-979-0569",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHYMIYMATTYMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-16",
        "last_updated": "2024-07-27",
        "certification_date": "2024-07-27",
        "status": "A",
        "authorized_official_last_name": "MATTY",
        "authorized_official_first_name": "MARIE",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-979-0569",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00041619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacifica Medicine and Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pacifica Medicine and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poulsbo, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2024; 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.