Active NPI
Matt P. Prewitt, P.A.-C
- Medical Physician Assistant
- Killeen, TX
National Provider Identifier
1023044898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA08154
- Practice address
- 2201 S Clear Creek Rd
Killeen, TX 76549-4110 - Phone
- (254) 519-8871
- NPI assigned
- Jun 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 98-PA17 | NM | |
| Medical Physician Assistant | 363AM0700X | PA08154 | TX | Primary |
Addresses
Primary practice location
2201 S Clear Creek Rd
Killeen, TX 76549-4110
Mailing address
100 High Trail Dr
Georgetown, TX 78633-4582
Phone (575) 770-1530
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 25070363 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA08154 | TX | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Affilion LLC | Past | Accepting new patients | |
| St. David'S Carenow Urgent Care PLLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Austin, TX
- NPI 1851844104
-
- Emergency Medical Services (Emergency Medicine) Physician
- Las Cruces, NM
- NPI 1720291529
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398729600000",
"number": "1023044898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 HIGH TRAIL DR",
"city": "GEORGETOWN",
"state": "TX",
"postal_code": "786334582",
"telephone_number": "575-770-1530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2201 S CLEAR CREEK RD",
"city": "KILLEEN",
"state": "TX",
"postal_code": "765494110",
"telephone_number": "254-519-8871"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PREWITT",
"first_name": "MATT",
"middle_name": "P.",
"name_prefix": "Mr.",
"credential": "P.A.-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-24",
"last_updated": "2014-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NM",
"license": "98-PA17",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA08154",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "25070363",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Killeen, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.