Dr Mariano De La Mata, MD | |
13506 Summerport Village Pkwy, #341, Windermere, FL 34786-7366 | |
(865) 406-9069 | |
Not Available |
Full Name | Dr Mariano De La Mata |
---|---|
Gender | Male |
Speciality | Internal Medicine |
Experience | 25 Years |
Location | 13506 Summerport Village Pkwy, Windermere, Florida |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1396841623 | NPI | - | NPPES |
3856126 | Medicaid | TN | |
4102788 | Other | TN | BCBS OF TENNESSEE |
3943623 | Medicaid | TN | |
64049224 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207P00000X | Emergency Medicine | ME99936 (Florida) | Primary |
Facility Name | Location | Facility Type |
---|---|---|
Mon Health Medical Center | Morgantown, WV | Hospital |
Mariners Hospital | Tavernier, FL | Hospital |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Shi Keys Llc | 2163835513 | 17 |
Mon Health Marion Neighborhood Hospital, Inc. | 3476943101 | 10 |
West Virginia Emergency Physicians Llp | 7618270323 | 12 |
Monongalia County General Hospital Company | 9638073380 | 178 |
Entity Name | Halifax Healthcare Systems Inc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1245283530 PECOS PAC ID: 1254238090 Enrollment ID: O20031218000443 |
Entity Name | Paragon Contracting Services Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1225071459 PECOS PAC ID: 3971417825 Enrollment ID: O20041207001148 |
Entity Name | Paragon Emergency Services Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1912101650 PECOS PAC ID: 8628153087 Enrollment ID: O20080310000143 |
Entity Name | Small Hospital Innovations |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1184040560 PECOS PAC ID: 0840415444 Enrollment ID: O20140715000513 |
Entity Name | Shi Keys Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1952903536 PECOS PAC ID: 2163835513 Enrollment ID: O20210105000345 |
Mailing Address | Practice Location Address |
---|---|
Dr Mariano De La Mata, MD 1200 J D Anderson Dr, Morgantown, WV 26505-3494 Ph: (304) 598-1200 | Dr Mariano De La Mata, MD 13506 Summerport Village Pkwy, #341, Windermere, FL 34786-7366 Ph: (865) 406-9069 |
Dr. Kimberly Ann Bruno-de La Mata, M.D. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 13506 Summerport Village Pkwy, #341, Windermere, FL 34786 Phone: 865-363-3330 | |
Dr. Brian Wiboon, DO Emergency Medicine Medicare: Medicare Enrolled Practice Location: 5143 Tildens Grove Blvd, Windermere, FL 34786 Phone: 407-656-9908 Fax: 407-656-9908 |