Matthew Pavelka, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

49333 Issued in AZ

Practice address

1003 Willow Creek Rd
Prescott, AZ 86301-1641

Phone

(928) 445-2700

NPI assigned

Jul 16, 2010

Last updated

Sep 4, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Medical Services of Prescott, Inc.

  • Emergency Medicine Physician
  • Prescott, AZ
  • NPI 1508816257
  Medicare reassignment NPD

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

{
    "created_epoch": "1279238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599177600000",
    "number": "1184937310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 HERONDO ST",
            "city": "HERMOSA BEACH",
            "state": "CA",
            "postal_code": "902545153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 WILLOW CREEK RD",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011641",
            "telephone_number": "928-445-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVELKA",
        "first_name": "MATTHEW",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-16",
        "last_updated": "2020-09-04",
        "certification_date": "2020-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "49333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "924528",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jyotsana M Patel, M.D.
• Rajiv Patel, M.D.
• Jennifer Mae Patterson, PT
• Sandra Patterson, LMT
• Brenda C Patton, MD
• Ben Eugene Paxton, M.D.
• PC Pain Doctors II, PLLC
• Peaks Primary Care, LLC
• Peaks Youth Behavioral Health Center, LLC
• Peaks Youth Behavioral Health Center, LLC

• Emergency Medicine Physician in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Emergency Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.