Charlie Mata, is a medicare enrolled "Registered Nurse" in Virginia Gardens, Florida. His current practice location is
6350 Nw 37th Ter, Virginia Gardens, Florida. You can reach out to his office (for appointments etc.) via phone at
(305) 469-6836.
Charlie Mata is licensed to practice in Florida (license number 9347349) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1013663343.
Provider's Profile
| Full Name | Charlie Mata |
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| Gender | Male |
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| Speciality | Registered Nurse |
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| Location | 6350 Nw 37th Ter, Virginia Gardens, Florida |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1013663343
- Provider Enumeration Date: 02/24/2022
- Last Update Date: 02/24/2022
Medicare PECOS Information:
- PECOS PAC ID: 5991230583
- Enrollment ID: I20241119003103
Medical Identifiers
Medical identifiers for Charlie Mata such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1013663343 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 163W00000X | Registered Nurse | 9347349 (Florida) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Charlie Mata allows following entities to bill medicare on his behalf.
| Entity Name | Holy Cross Hospital Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1467401877
PECOS PAC ID: 1850298365
Enrollment ID: O20031215000087 |
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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. Charlie 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 |
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Charlie Mata,
6350 Nw 37th Ter,
Virginia Gardens, FL 33166-7031
Ph: (305) 469-6836 | Charlie Mata,
6350 Nw 37th Ter,
Virginia Gardens, FL 33166-7031
Ph: (305) 469-6836 |
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