Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1245438704 Individual Practitioner Male Practitioner

Charles Sedillo Mata , CO

Specialist • Crestview, FL

Professional Overview & Biography Verified Profile Summary

Charles Mata, CO is a registered healthcare professional specializing in Specialist in Crestview, FL. Practice services are available at 4100 S FERDON BLVD under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4100 S Ferdon Blvd
B-4

Crestview, FL 325365252

Telephone 8504490380
Associated Practice Facility / Clinic
🏢 Prime Therapy, Inc Facility NPI 1316996713

Specialty Benchmarks & Practice Insights

Comparative analytics for Specialist in Crestview, FL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 43.0 Yrs
State Avg: 37.8 Yrs
Regional Practice Density
7 Specialists

Practicing in Crestview, FL (3036 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Specialist Primary Specialty

NUCC Taxonomy Code: 174400000X

State License FL ORT157

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

13 Associated Practitioners
Jessica Gibson , MSN, CNM, ARNP

Advanced Practice Midwife

NPI 1013213057

Master of Science in Nursing, Certified Nurse Midwife, Advanced Registered Nurse Practitioner

Randyn Mcmillan , CO, LDO

Technician/Technologist - Orthoptist

NPI 1124775168

Certified Orthotist, LDO

Allison Rivers

Speech-Language Pathologist

NPI 1184013385
Diana Gibbs

Physical Therapist

NPI 1225839731
Stacy Taylor

Occupational Therapist

NPI 1285879783
Desiray Greer

Behavior Analyst

NPI 1396396495

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active November 01, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location November 01, 2007

Registered at 4100 S FERDON BLVD, B-4, CRESTVIEW, FL 325365252 (Tel: 8504490380)

📍
Updated Business Mailing Address November 01, 2007

Registered at 1920 E HATTON ST, PENSACOLA, FL 325034842 (Tel: 8504490380)

👤
Provider Name / Credentials Updated November 01, 2007

Recorded as CHARLES MATA, CO

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) November 01, 2007

Specialist (License #ORT157 in FL)

🟢
Initial NPI Registration & Enumeration July 06, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1245438704
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 06, 2007
Last Update: November 01, 2007
Sole Proprietor: No

Mailing Address

1920 E Hatton St

Pensacola, FL 325034842

Phone: 8504490380

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.