Individual provider Active NPI

Matthew Chan, PA-C

  • Physician Assistant
  • New York, NY
National Provider Identifier
1053002535
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
030957 Issued in NY
Practice address
541 E 71St St FL 1
New York, NY 10021-4871
Phone
(212) 606-1136
Fax
(212) 606-1109
NPI assigned
May 16, 2023
Last updated
Nov 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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
Physician Assistant 363A00000X 030957 NY Primary

Addresses

Primary practice location

541 E 71St St FL 1
New York, NY 10021-4871

Mailing address

535 E 70TH St
New York, NY 10021-4823
Phone (212) 606-1136

Other practice location 1

535 E 70th St
New York, NY 10021-4823
Phone (212) 606-1136

Other practice location 2

333 Earle Ovington Blvd Ste 106
Uniondale, NY 11553-3645
Phone (212) 606-1136

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address mchan106886@direct.hss.edu Direct
FHIR URL https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/ Direct
FHIR URL https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2 Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20240214001619 NY Practitioner - Physician Assistant 2163866534 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Modern Physician Services PCGroup PAC ID 6204140544, 55 clinicians

Practice addresses (Care Compare)

1169 Liberty Ave
Brooklyn, NY 11208-3308
Phone (646) 604-8180

1248 Fulton St
Brooklyn, NY 11216-2003
Phone (646) 604-8130

436 Utica Ave
Brooklyn, NY 11213-5903
Phone (646) 604-8150

68 Graham Ave
Brooklyn, NY 11206-4017
Phone (646) 604-8130

916 Flatbush Ave
Brooklyn, NY 11226-4018
Phone (646) 604-8140

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
SBH Physicians, PC Physician Assistant CurrentSince May 22, 2025 Accepting new patients
Lawrence V. Gulotta MD PC CurrentSince Nov 3, 2024 Accepting new patients
A.T. Still University - College for Healthy Communities PastSince Sep 14, 2025 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

535 E 70th St
New York, NY 10021

541 E 71st St
New York, NY 10021
Phone (212) 606-1136

541 E 71st St
Fl 1
New York, NY 10021
Phone (212) 606-1136

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1684195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1053002535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 E 70TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214823",
            "telephone_number": "212-606-1136",
            "fax_number": "212-606-1109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 E 71ST ST FL 1",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214871",
            "telephone_number": "212-606-1136",
            "fax_number": "212-606-1109"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "535 E 70th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100214823",
            "country_code": "US",
            "telephone_number": "212-606-1136",
            "fax_number": "212-606-1109",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "333 Earle Ovington Blvd Ste 106",
            "address_purpose": "LOCATION",
            "city": "Uniondale",
            "state": "NY",
            "postal_code": "115533645",
            "country_code": "US",
            "telephone_number": "212-606-1136",
            "fax_number": "212-606-1109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAN",
        "first_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-16",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "030957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mchan106886@direct.hss.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "535 E 70th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214823",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "535 E 70th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214823",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "535 E 70th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214823",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.