FIDEL MATA (NPI# 1558445924) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558445924 |
| Entity Type | Individual |
| Full Name | FIDEL MATA |
| Credential | P.A. |
| Practice Address |
1800 E Lake Shore Dr Decatur IL 62521-3810 |
| Practice Telephone | 2174226100 |
| Practice Fax Number | 2174223217 |
| Mailing Telephone | 2174226100 |
| Mailing Fax Number | 2174223217 |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2019-05-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
085.002235 | IL | Allopathic & Osteopathic Physicians |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
085-002235 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1800 E LAKE SHORE DR |
| City | DECATUR |
| State | IL |
| Zip Code | 62521-3810 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326041229 | St Marys Hospital Sisters of The Third Order of St Francis | General Acute Care Hospital | 1800 E Lake Shore Dr, Decatur, IL 62521 | 2005-05-24 |
| 1093349912 | Nicholas Halford | Nurse Anesthetist, Certified Registered | 1800 E Lake Shore Dr, Decatur, IL 62521-3810 | 2020-02-29 |
| 1295368207 | Amanda Durbin | Nurse Anesthetist, Certified Registered | 1800 E Lake Shore Dr, Decatur, IL 62521-3810 | 2020-02-18 |
| 1194362392 | Cassie Briggs | Nurse Practitioner | 1800 E Lake Shore Dr, Decatur, IL 62521-3883 | 2019-12-06 |
| 1093351413 | Megan Leech | Advanced Practice Midwife | 1800 E Lake Shore Dr, Decatur, IL 62521-3810 | 2019-11-20 |
| 1992355812 | Gideon Nkrumah | Nurse Anesthetist, Certified Registered | 1800 E Lake Shore Dr, Decatur, IL 62521-3883 | 2019-09-12 |
| 1407417181 | Komal J Patel | Dietitian, Registered | 1800 E Lake Shore Dr, Decatur, IL 62521-3810 | 2019-06-24 |
| 1760940712 | Emily Ann Foster | Internal Medicine | 1800 E Lake Shore Dr, Decatur, IL 62521-3810 | 2019-03-08 |
| 1477010874 | Jennifer Diann Pieper | Nurse Anesthetist, Certified Registered | 1800 E Lake Shore Dr, Decatur, IL 62521-3810 | 2019-02-22 |
| 1760955298 | Hailey Michelle Williams | Dietitian, Registered | 1800 E Lake Shore Dr, Decatur, IL 62521-3810 | 2019-01-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053927988 | Caleb David Braasch | Pharmacist | 1818 South Airport Rd, Decatur, IL 62521 | 2020-09-16 |
| 1295390490 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | Crossing Recovery Center, 495 East Central Ave, Decatur, IL 62521 | 2019-05-03 |
| 1396300638 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 E Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1679138911 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 East Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1154848034 | Zack Shaw | Physical Therapist | 4855-57 East 36, Decatur, IL 62521 | 2017-08-23 |
| 1790032852 | Prashant Morolia | Family Medicine | 4775 E Maryland St, Decatur, IL 62521 | 2012-08-08 |
| 1003188913 | Evergreen Place Decatur, LLC | Assisted Living Facility | 4825 E Evergreen Court, Decatur, IL 62521 | 2012-02-08 |
| 1104133099 | Suzette Marie Shafer | Occupational Therapy Assistant | 1790 S. Fairview Ave., Decatur, IL 62521 | 2010-09-13 |
| 1467784090 | Community Health Improvement Center | Clinic/Center | 1221 East Condit Street, Decatur, IL 62521 | 2010-02-08 |
| 1982839056 | Kelly Clark Dds PC | Dentist | 3737 Us Rt 36 E, Decatur, IL 62521 | 2009-05-19 |
| Find all providers in zip 62521 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487291878 | Ashley Cohen | Physician Assistant | 250 E Ponce De Leon Ave Ste 800, Decatur, GA 30030-3438 | 2019-12-04 |
| 1932757606 | Andrea J Holley | Physician Assistant | 1629 Austin Meadows Dr, Decatur, GA 30032-3888 | 2019-08-27 |
| 1073904181 | Nathan Potter | Physician Assistant | 798 Larry Ln, Decatur, GA 30033-4817 | 2015-02-11 |
| 1932467479 | Shannon L Hill | Physician Assistant | 1074 Ashbury Dr, Decatur, GA 30030-4165 | 2012-05-02 |
| 1578754792 | John Cicero Crawford II | Physician Assistant | 3941 John Hopkins Ct, Decatur, GA 30034-5709 | 2007-08-05 |
| 1437299773 | Barbar A Young | Physician Assistant | 3290 Memorial Dr Ste B3, Decatur, GA 30032-3400 | 2007-02-07 |
| 1992842595 | Veronica G Dockery | Physician Assistant | 346 N. Main St, Decatur, AR 72722-0735 | 2007-01-31 |
| 1649344938 | Telicia Dequai Scott | Physician Assistant | 4153b Flat Shoals Pkwy Ste 200, Decatur, GA 30034-4189 | 2006-11-20 |
| 1699773234 | Joanne Gilby Beer | Physician Assistant | 3292 Mountain Dr Ste A, Decatur, GA 30032-1102 | 2005-07-08 |
| 1871063263 | Paige Birge | Physician Assistant | 2300 N Edward St, Decatur, IL 62526-4163 | 2018-11-28 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.