Individual provider Active NPI

Kevin Charles Matthews, LO

  • Orthotist
  • Live Oak, TX
National Provider Identifier
1093887440
Registry record updated Dec 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OrthotistTaxonomy code 222Z00000X
License
558 Issued in TX
Practice address
12315 Judson Rd
#206
Live Oak, TX 78233-3277
Phone
(210) 657-8100
Fax
(210) 657-8105
NPI assigned
Nov 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthotist 222Z00000X 558 TX Primary

Addresses

Primary practice location

12315 Judson Rd
#206
Live Oak, TX 78233-3277

Mailing address

12315 Judson Rd
#206
Live Oak, TX 78233-3277
Phone (210) 657-8100

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
558TXMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Orthopedic Designs, LLC Orthotist PastSince Dec 5, 2021 Accepting new patients
Advanced Orthopedic Designs, LLC Orthotist Past Accepting new patients

Organizations & group practices 2

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": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199059200000",
    "number": "1093887440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12315 JUDSON RD",
            "address_2": "#206",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "782333277",
            "telephone_number": "210-657-8100",
            "fax_number": "210-657-8105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12315 JUDSON RD",
            "address_2": "#206",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "782333277",
            "telephone_number": "210-657-8100",
            "fax_number": "210-657-8105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTHEWS",
        "first_name": "KEVIN",
        "middle_name": "CHARLES",
        "name_prefix": "Mr.",
        "credential": "LO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2007-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "TX",
            "license": "558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Live Oak, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.