Individual provider Active NPI

Matthew John Morrison, PA-C

  • Medical Physician Assistant
  • Port Orange, FL
National Provider Identifier
1104814177
Registry record updated Apr 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA 9100655 Issued in FL
Practice address
1690 Dunlawton Ave Ste 210
Port Orange, FL 32127-8980
Phone
(386) 763-4920
Fax
(386) 763-4939
NPI assigned
Oct 12, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA 9100655 FL Primary

Addresses

Primary practice location

1690 Dunlawton Ave Ste 210
Port Orange, FL 32127-8980

Mailing address

2805 S Asciano CT
New Smyrna Beach, FL 32168-6322
Phone (386) 566-0584

Other identifiers 1

IdentifierTypeStateIssuer
290535300MedicaidFL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120322000466 FL Practitioner - Physician Assistant 8820258270 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Halifax Healthcare Systems IncGroup PAC ID 1254238090, 345 clinicians

Practice addresses (Care Compare)

1041 Dunlawon Ave
Port Orange, FL 32127-7968
Phone (386) 322-4700

303 N Clyde Morris Blvd
Daytona BCH, FL 32114-2709

3300 E Halifax Crossing Blvd
Deltona, FL 32725-2911
Phone (386) 425-6100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA 9100655FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Halifax Healthcare Systems Inc CurrentSince Mar 5, 2012 Accepting new patients

Locations

303 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 425-2285

303 N Clyde Morris Blvd
Jacksonville, FL 32214

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619740800000",
    "number": "1104814177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 S ASCIANO CT",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321686322",
            "telephone_number": "386-566-0584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 DUNLAWTON AVE STE 210",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321278980",
            "telephone_number": "386-763-4920",
            "fax_number": "386-763-4939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORRISON",
        "first_name": "MATTHEW",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA 9100655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290535300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

Verify at the official NPI Registry.