Fidel Mata, PA is a medicare enrolled "Physician Assistant - Medical" physician in Decatur, Illinois. He graduated from medical school in 2002 and has 22 years of diverse experience with area of expertise as Physician Assistant. He is a member of the group practice Prairie Cardiovascular Consultants Ltd and his current practice location is
1770 E Lake Shore Dr Ste 105, Decatur, Illinois. You can reach out to his office (for appointments etc.) via phone at
(217) 422-6100.
Fidel Mata is licensed to practice in Illinois (license number 085-002235) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1558445924.
Physician's Profile
| Full Name | Fidel Mata |
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| Gender | Male |
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| Speciality | Physician Assistant |
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| Experience | 22 Years |
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| Location | 1770 E Lake Shore Dr Ste 105, Decatur, Illinois |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Fidel Mata graduated from medical school in 2002
NPI Data:
- NPI Number: 1558445924
- Provider Enumeration Date: 10/24/2006
- Last Update Date: 12/20/2021
Medicare PECOS Information:
- PECOS PAC ID: 2163493156
- Enrollment ID: I20040803001529
Medical Identifiers
Medical identifiers for Fidel Mata such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1558445924 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207RC0000X | Internal Medicine - Cardiovascular Disease | 085.002235 (Illinois) | Secondary |
| 363AM0700X | Physician Assistant - Medical | 085-002235 (Illinois) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Prairie Cardiovascular Consultants Ltd | 3173435880 | 85 |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Fidel Mata is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Fidel Mata, PA
1770 E Lake Shore Dr Ste 105,
Decatur, IL 62521-3800
Ph: (217) 422-6100 | Fidel Mata, PA
1770 E Lake Shore Dr Ste 105,
Decatur, IL 62521-3800
Ph: (217) 422-6100 |
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