Amanda Matilda Regodon Wallin, MD, MPH

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A190935 Issued in CA

Practice address

1950 Alameda de Las Pulgas
San Mateo, CA 94403-1222

Phone

(650) 573-3571

Fax

(650) 572-9347

NPI assigned

Mar 25, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

County of San MateoGroup PAC ID 9032023171, 316 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• County of San Mateo

  • Multi-Specialty Clinic/Center
  • San Mateo, CA
  • NPI 1679642326
  Medicare reassignment Care Compare group NPD
• County of San Mateo

  • Community/Behavioral Health Agency
  • Redwood City, CA
  • NPI 1528432481
  NPD
• San Mateo County

  • Adolescent and Children Mental Health Clinic/Center
  • South San Francisco, CA
  • NPI 1811089659
  NPD

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

{
    "created_epoch": "1585094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1982231205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 ALAMEDA DE LAS PULGAS",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944031222",
            "telephone_number": "650-573-3571",
            "fax_number": "650-572-9347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 ALAMEDA DE LAS PULGAS",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944031222",
            "telephone_number": "650-573-3571",
            "fax_number": "650-572-9347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REGODON WALLIN",
        "first_name": "AMANDA MATILDA",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-25",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "PTL4010",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A190935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Reed
• Karmen Marie Reeves
• Karina Regalado
• Regional Diagnostic Imaging
• Lisa Dawn Register
• Taea Raven Regua, BT/RBT
• Rehabilitation Physicians
• Laurel M. Reid, D. C.
• Kendall Reiner
• Clifford Reis

• Psychiatry Physician in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.