MARIO MATA
NPI 1053057117
Nurse Practitioner - Adult Health in Kirkland, WA
About Mario Mata NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MARIO MATA (NPI 1053057117) is an individual adult health provider in Kirkland, Washington, licensed in Washington (AP60886621) and active in the NPI registry since May 2022. He is enrolled in Medicare PECOS and is a graduate of Other (2018).
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Mario Mata is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Mario Mata reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Edgewood, WA 98371
- Reassigned Medicare billing, Washington enrollment
- 19 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 8
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 98034 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
KIRKLAND, WA 98034
KIRKLAND, WA 98034
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Mario Mata's NPI number?
The NPI number for Mario Mata is 1053057117. It was assigned to this individual provider in the NPPES registry on May 10, 2022.
Where is Mario Mata located?
Mario Mata practices at 10200 NE 132nd St, Kirkland, WA 98034. The listed phone number is (425) 821-2000.
What is Mario Mata's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.
Is Mario Mata enrolled in Medicare?
Yes. Mario Mata is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Mario Mata's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mario Mata reassigns Medicare benefits to Rejuvenation Medical PLLC (Edgewood, WA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mario Mata's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Mario Mata was last updated on May 10, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mario Mata · NPI 1053057117
Adult Health physician in Kirkland, Washington. Individual provider, active in the CMS NPPES registry since May 10, 2022.
## Identity
- **NPI:** 1053057117 (Entity type: Individual)
- **Enumerated:** May 10, 2022
- **Primary specialty:** Nurse Practitioner - Adult Health · taxonomy 363LA2200X
- **State license:** AP60886621 (Washington)
- **Sole proprietor:** No
## Practice location
- **Address:** 10200 NE 132ND ST, Kirkland, WA 98034-2831
- **Phone:** (425) 821-2000
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Rejuvenation Medical PLLC (NPI 1447712559, Edgewood, WA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2018
## Record status
- **NPPES last updated:** May 10, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1053057117) · Data from the CMS NPPES public registry.