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RAVEENA MATA MD
NPI 1710776562
Student in an Organized Health Care Education/Training Program in Detroit, MI

Active since May 06, 2025PECOS Enrolled
2799 W GRAND BLVD, DETROIT, MI 48202(313) 916-2600 Get Directions Write a Review

NPPES record last updated: September 11, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 11, 2025, May 16, 2025, May 6, 2025 (3 updates tracked since 2025).

About Raveena Mata Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RAVEENA MATA MD (NPI 1710776562) is an individual student in an organized health care education/training program in Detroit, Michigan and active in the NPI registry since May 2025. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1710776562
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameRAVEENA MATACredential: MD
Location Address2799 W GRAND BLVDDetroit, MI 48202-2608
Mailing Address2799 W Grand BlvdDetroit, MI 48202-2608
Phone(313) 916-2600
Sole ProprietorNo
Enumeration DateMay 6, 2025
Last NPPES UpdateSeptember 11, 20253 updates tracked since enumeration
NPPES CertifiedMay 16, 2025
✔ NPI 1710776562 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Raveena Mata Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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.

HENRY FORD HOSPITAL
General Acute Care Hospital
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600
DR. BRENT DAVID GRIFFITH M.D.
Radiology (Diagnostic Radiology)
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600
KANIKA KHANNA M.D
Radiology (Diagnostic Radiology)
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600
DR. FADL A CHOKR M.D.
Family Medicine
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600
AVI COHEN M.D.
Internal Medicine (Pulmonary Disease)
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600
LINDSEY AURORA
Internal Medicine (Cardiovascular Disease)
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600
KYLE KRUPA
Nurse Anesthetist, Certified Registered
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600
ALEXANDER GARBARINO
Internal Medicine (Pulmonary Disease)
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600

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 Raveena Mata's NPI number?

The NPI number for Raveena Mata is 1710776562. It was assigned to this individual provider in the NPPES registry on May 6, 2025.

Where is Raveena Mata located?

Raveena Mata practices at 2799 W Grand Blvd, Detroit, MI 48202. The listed phone number is (313) 916-2600.

What is Raveena Mata's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Raveena Mata enrolled in Medicare?

Yes. Raveena Mata is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Raveena Mata was last updated on September 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months 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.