Physician Compare National (NPI:1104093301)

HEALTHCARE PROVIDER: TIM MATATOV M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1104093301
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8527350149
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160630000064
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MATATOV
	Individual professional last name
Provider First Name	TIM
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2007
	Individual professional's medical school graduation year
Primary Specialty	PLASTIC AND RECONSTRUCTIVE SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	10910 N TATUM BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE B100
	Group Practice or individual's line 2 address
City	PHOENIX
	Group Practice or individual's city
State	AZ
	Group Practice or individual's state
Zip Code	850283080
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	030038
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SCOTTSDALE OSBORN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	030092
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	HONORHEALTH DEER VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y