Individual provider Active NPI

Matthew Brian Hamilton Williams, PA-C

  • Physician Assistant
  • Bloomington, MN
National Provider Identifier
1023779626
Registry record updated Mar 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14002 Issued in MN
Practice address
4300 Marketpointe Dr Ste 100
Bloomington, MN 55435-5435
Phone
(952) 835-9880
Fax
(952) 857-1554
NPI assigned
Jan 5, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 14002 MN Primary

Addresses

Primary practice location

4300 Marketpointe Dr Ste 100
Bloomington, MN 55435-5435

Mailing address

4300 Marketpointe Dr Ste 100
Bloomington, MN 55435-5435
Phone (952) 835-9880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220420001190 MN Practitioner - Physician Assistant 1759778897 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
May accept Medicare assignment
Group practices
Advocate Urgent Care PLLCGroup PAC ID 4880043082, 18 clinicians
MN UC Providers LTDGroup PAC ID 8729461421, 14 clinicians
Ridgeview Medical CenterGroup PAC ID 9234041997, 407 clinicians

Practice addresses (Care Compare)

11091 Jason Ave NE
Suite 300
Albertville, MN 55301-4699
Phone (763) 260-4750

12643 Fremont Ave
Zimmerman, MN 55398-9755
Phone (218) 838-9355

13540 Grove Dr N
Maple Grove, MN 55311-4400
Phone (952) 931-1276

415 17TH Ave N
Suite 100
Hopkins, MN 55343-7226
Phone (952) 931-1276

560 S Maple St
Waconia, MN 55387-1759

7907 Powers Blvd
Chanhassen, MN 55317-9502
Phone (952) 934-0570

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
94.23
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14002MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
MN UC Providers LTD CurrentSince Feb 6, 2025 Accepting new patients

Locations

415 17th Ave N
Ste 100
Hopkins, MN 55343
Phone (952) 931-1276

13540 Grove Dr N
Maple Grove, MN 55311
Phone (952) 931-1276

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1641340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647302400000",
    "number": "1023779626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 MARKETPOINTE DR STE 100",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554355435",
            "telephone_number": "952-835-9880",
            "fax_number": "952-857-1554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 MARKETPOINTE DR STE 100",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554355435",
            "telephone_number": "952-835-9880",
            "fax_number": "952-857-1554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "MATTHEW",
        "middle_name": "BRIAN HAMILTON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-05",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

Verify at the official NPI Registry.