Matthew M Hendricks, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9111716 Issued in NU

Practice address

2838 E. Oakland Park Boulevard
S. 201
Fort Lauderdale, FL 33306

Phone

(954) 564-0040

Fax

(954) 217-3222

NPI assigned

Oct 8, 2018

Last updated

Dec 22, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Leavitt Medical Associates of Florida Inc

  dba Advanced Dermatology and Cosmetic Surq

  • Dermatology Physician
  • Sebastian, FL
  • NPI 1083872535
  Medicare reassignment NPD
• South Florida Surgical Specialists LLC

  • Surgery Physician
  • Coral Springs, FL
  • NPI 1952409963
  Medicare reassignment
• Leavitt Medical Associates of Florida Inc

  dba Advanced Dermatology and Cosmetic Surgery

  • Dermatology Physician
  • Palm Coast, FL
  • NPI 1902067671
  NPD
• Leavitt Medical Associates of Florida Inc

  dba Advanced Dermatology And Cosmetic Surgery

  • Dermatology Physician
  • Heathrow, FL
  • NPI 1528097284
  NPD (past)
• Skin and Cancer Associates

  • Dermatology Physician
  • Plantation, FL
  • NPI 1740737576
  NPD (past)

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

{
    "created_epoch": "1538956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671667200000",
    "number": "1033684873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2838 E. OAKLAND PARK BOULEVARD",
            "address_2": "S. 201",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "33306",
            "telephone_number": "954-564-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2838 E. OAKLAND PARK BOULEVARD",
            "address_2": "S. 201",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "33306",
            "telephone_number": "954-564-0040",
            "fax_number": "954-217-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKS",
        "first_name": "MATTHEW",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-08",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": "PA9111716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Henderson Behavioral Health
• Henderson Behavioral Health, Inc.
• Henderson Behavioral Health, Inc.
• Henderson Behavioral Health, Inc.
• Melanie Anne Henderson, PT
• Cory Scott Hennessey, DC
• Allison Hennessy, M.S.
• Rosalba R Henninger, D.D.S.
• Lori Henricksen, MS, OTR/L-BCP
• Jose Fernando Henriquez Zschecher, ME175740

• Physician Assistant in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.