BRIANNA TERESE MATUNDULO PA-C
NPI 1720810351
Physician Assistant in Madison, WI

Q: What is Brianna Matundulo's NPI number?

The NPI number for Brianna Matundulo is 1720810351. It was assigned to this individual provider in the NPPES registry on August 14, 2024. The provider is also known as Brianna Terese Mark.

Q: What is Brianna Matundulo's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Brianna Matundulo was last updated on September 24, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 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.

Active since August 14, 2024PECOS EnrolledAccepts Medicare Assignment

1821 S STOUGHTON RD, MADISON, WI 53716(608) 260-6000(608) 260-6366 Get Directions Write a Review

NPPES record last updated: September 24, 2024. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Sep 24, 2024, Aug 14, 2024 (2 updates tracked since 2024).

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About Brianna Terese Matundulo Pa-c NPPES

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

BRIANNA TERESE MATUNDULO PA-C (NPI 1720810351) is an individual physician assistant in Madison, Wisconsin, licensed in Wisconsin (8069-23) and active in the NPI registry since August 2024. She is enrolled in Medicare PECOS, is affiliated with Ssm Health St Mary's Hospital - Madison, and is a graduate of Other (2024).

NPPES Registry Identity

NPI1720810351

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameBRIANNA TERESE MATUNDULOCredential: PA-C

Location Address1821 S STOUGHTON RDMadison, WI 53716-2257

Mailing AddressW204n12570 Goldendale RdRichfield, WI 53076-9769 · (262) 423-3820

Phone(608) 260-6000

Fax(608) 260-6366

Sole ProprietorNo

Medical School CMSOtherGraduated 2024

Enumeration DateAugust 14, 2024

Last NPPES UpdateSeptember 24, 20242 updates tracked since enumeration

NPPES CertifiedSeptember 24, 2024

✔ NPI 1720810351 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in WI · 8069-23

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

1821 S STOUGHTON RD, Madison, WI 53716

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Other Names 1

Former Name (1)Brianna Terese Mark

Other Identifiers 1

Medicaid1720810351WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Brianna Terese Matundulo Pa-c 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.

PECOS PAC ID7113458894

PECOS Enrollment IDI20241004002642

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.

Areas of Expertise CMS Part B claims

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.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

13 services12 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Ssm Health St Mary's Hospital - Madison

Acute Care Hospitals · Madison, WI

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number520083

Location700 South Park StMadison, WI 53715 · Dane County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53716 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$67.37 typical visit price

range $17.40 – $133.76

Typical copayment $16.84 (range $4.35 – $33.44)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

NATHAN JUNG M.D.

Urology