NPIMap

Individual provider Active NPI

Matthew Ethan Johnson, PA-C

  • Physician Assistant
  • State College, PA
National Provider Identifier
1023398302
Registry record updated Sep 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
164 Greenview Dr Ste 345
State College, PA 16803-2106
Phone
(814) 234-7599
Fax
(814) 237-2126
NPI assigned
Aug 18, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA Primary
Physician Assistant 363A00000X 2609 CT

Addresses

Primary practice location

164 Greenview Dr Ste 345
State College, PA 16803-2106

Mailing address

155 Wellness Way
State College, PA 16803-6702
Phone (814) 231-7000

Other practice location 1

700 High St
Williamsport, PA 17701-3100
Phone (703) 585-0221

Other practice location 2

24 Stevens St
Norwalk, CT 06856
Phone (203) 852-2189

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address UPMCHOSPITALS@upmcdirect.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190128000137 PA Practitioner - Physician Assistant 4789834672 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Susquehanna Physician ServicesGroup PAC ID 2264336460, 611 clinicians
Mount Nittany Medical Center Health Services IncGroup PAC ID 8426136797, 366 clinicians

Practice addresses (Care Compare)

1100 Grampian Blvd
Williamsport, PA 17701-1909
Phone (570) 326-8005

129 Medical Park LN
Bellefonte, PA 16823-9112
Phone (814) 355-3626

141 Medical Park LN
Bellefonte, PA 16823-9112
Phone (814) 355-7322

143 Hospital Dr
State College, PA 16803-5500
Phone (814) 237-3470

155 Wellness Way
State College, PA 16803-6702

700 High St
Williamsport, PA 17701-3100
Phone (570) 321-1980

700 High St
Williamsport, PA 17701-3198

Hospital & facility affiliations

  • Mount Nittany Medical Center Hospital, State College, PA, CCN 390268
  • Upmc Williamsport Hospital, Williamsport, PA, CCN 390045

Merit-based Incentive Payment System (MIPS)

Final score
81.06 of 100Reported as group
Quality
62.07
Promoting interoperability
100
Improvement activities
40
Cost
74.81

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2609CTMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Nittany Medical Center Health Services Inc CurrentSince Oct 27, 2025 Accepting new patients
Susquehanna Physician Services Physician Assistant CurrentSince Jan 2, 2019 Accepting new patients
Susquehanna Physician Services CurrentSince Jan 2, 2019 Accepting new patients
Susquehanna Physician Services Past Accepting new patients
Mount Nittany Medical Center Health Services Inc PastSince Sep 28, 2025 Accepting new patients

Locations

141 Medical Park Ln
Bellefonte, PA 16823
Phone (814) 355-7322

164 Greenview Dr
Ste 345
State College, PA 16803
Phone (814) 234-7599

164 Greenview Dr
Ste 200
State College, PA 16803
Phone (814) 237-4321

155 Wellness Way
State College, PA 16803
Phone (800) 367-0179

1850 E Park Ave
Ste 201
State College, PA 16803
Phone (814) 234-8800

1100 Grampian Blvd
Williamsport, PA 17701
Phone (570) 326-8005

1201 Grampian Blvd
Williamsport, PA 17701
Phone (570) 326-8723

700 High St
Williamsport, PA 17701
Phone (570) 321-1000

Organizations & group practices 5

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758844800000",
    "number": "1023398302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 WELLNESS WAY",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036702",
            "telephone_number": "814-231-7000",
            "fax_number": "814-231-7098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 GREENVIEW DR STE 345",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168032106",
            "telephone_number": "814-234-7599",
            "fax_number": "814-237-2126"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 High St",
            "address_purpose": "LOCATION",
            "city": "Williamsport",
            "state": "PA",
            "postal_code": "177013100",
            "country_code": "US",
            "telephone_number": "703-585-0221",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24 Stevens St",
            "address_purpose": "LOCATION",
            "city": "Norwalk",
            "state": "CT",
            "postal_code": "06856",
            "country_code": "US",
            "telephone_number": "203-852-2189",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MATTHEW",
        "middle_name": "ETHAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-18",
        "last_updated": "2025-09-26",
        "certification_date": "2025-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "2609",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "UPMCHOSPITALS@upmcdirect.edu",
            "affiliation": "N",
            "address_1": "700 High St",
            "city": "Williamsport",
            "state": "PA",
            "country_code": "US",
            "postal_code": "177013100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.