Individual provider Active NPI

Matthew Bryan Hanna, PA

  • Physician Assistant
  • Aiken, SC
National Provider Identifier
1063405942
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1066581 Issued in GA
Practice address
6167 Braided Mane Pass SW
Aiken, SC 29803-7839
Phone
(803) 648-1464
Fax
(803) 649-2027
NPI assigned
Aug 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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 1066581 GA Primary

Addresses

Primary practice location

6167 Braided Mane Pass SW
Aiken, SC 29803-7839

Mailing address

308 Floyd St
Hinesville, GA 31313-5509
Phone (912) 369-4789

Other practice location 1

192 Lindquist Rd
Bldg 412
Ft Stewart, GA 31314-5122
Phone (912) 435-6965

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20220215000263 SC Practitioner - Physician Assistant 4385037399 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Urgent Cares LLCGroup PAC ID 8628502598, 183 clinicians

Practice addresses (Care Compare)

6167 Braided Mane Pass SW
Aiken, SC 29803-7839
Phone (803) 648-1464

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1066581GAMDPhysician Assistant

Organizations & group practices 1

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": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1063405942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 FLOYD ST",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313135509",
            "telephone_number": "912-369-4789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6167 BRAIDED MANE PASS SW",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298037839",
            "telephone_number": "803-648-1464",
            "fax_number": "803-649-2027"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "192 Lindquist Rd",
            "address_2": "Bldg 412",
            "address_purpose": "LOCATION",
            "city": "Ft Stewart",
            "state": "GA",
            "postal_code": "313145122",
            "country_code": "US",
            "telephone_number": "912-435-6965",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANNA",
        "first_name": "MATTHEW",
        "middle_name": "BRYAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "1066581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aiken, SC

Sources for this page

Verify at the official NPI Registry.