Active NPI
Matthew William Sprunt, PA-C
- Physician Assistant
- Lake Wales, FL
National Provider Identifier
1083862544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9108450
- Practice address
- 1354 State Road 60 E
Lake Wales, FL 33853-4322 - Phone
- (863) 679-8888
- NPI assigned
- Sep 8, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9108450 | FL | Primary |
Addresses
Primary practice location
1354 State Road 60 E
Lake Wales, FL 33853-4322
Mailing address
1354 State Road 60 E
Lake Wales, FL 33853-4322
Phone (863) 679-8888
Other practice location 1
610 sycamore street
ste 130
Celebration, FL 34747
Phone (407) 990-1000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9108450 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559174400000",
"number": "1083862544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1354 STATE ROAD 60 E",
"city": "LAKE WALES",
"state": "FL",
"postal_code": "338534322",
"telephone_number": "863-679-8888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1354 STATE ROAD 60 E",
"city": "LAKE WALES",
"state": "FL",
"postal_code": "338534322",
"telephone_number": "863-679-8888"
}
],
"practiceLocations": [
{
"address_1": "610 sycamore street",
"address_2": "ste 130",
"address_purpose": "LOCATION",
"city": "Celebration",
"state": "FL",
"postal_code": "34747",
"country_code": "US",
"telephone_number": "407-990-1000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SPRUNT",
"first_name": "MATTHEW",
"middle_name": "WILLIAM",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-09-08",
"last_updated": "2019-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9108450",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Wales, FL
- Specialty Orthopedic Associates PL
- Speech Savvy Therapy Services, LLC
- Shelly Kay Spencer, M.A. CCC-SLP
- Claudia Spiker
- Sports and Orthopedic Rehabilitation Services Inc (Select Physical Therapy)
- SS Polk II Community HC LLC (Groves Center)
- Matthew Michael Stanley, LPC
- Jennifer Michele Steele, APRN
- Floyd Allen Stern, MD
- La Kenya Delon Stone, CNA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.