Individual provider Active NPI

Matthew R Fernandez, PA-C

  • Surgical Physician Assistant
  • Middletown, CT
National Provider Identifier
1205006822
Registry record updated Feb 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
002064 Issued in CT
Practice address
410 Saybrook Rd Ste 100
Middletown, CT 06457-4780
Phone
(860) 685-8940
Fax
(860) 685-8944
NPI assigned
Mar 11, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 002064 CT Primary

Addresses

Primary practice location

410 Saybrook Rd Ste 100
Middletown, CT 06457-4780

Mailing address

410 Saybrook Rd Ste 100
Middletown, CT 06457-4780
Phone (860) 685-8940

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20080502000239 CT Practitioner - Physician Assistant 1759460702 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

512 Saybrook Rd
Suite 100
Middletown, CT 06457-4788
Phone (860) 347-7636

6 Greenwich Office Park
Greenwich, CT 06831-5151
Phone (203) 869-1145

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.22 of 100Reported as group
Quality
82.55
Promoting interoperability
100
Improvement activities
40
Cost
64.86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
002064CTMDPediatric Nutrition Registered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic & Neurosurgery Specialists, PLLC CurrentSince Dec 1, 2021 Accepting new patients

Locations

6 Greenwich Office Park
Greenwich, CT 06831
Phone (203) 869-1145

117 Main St
Ste 202
Hebron, CT 06248

117 Main St
Hebron, CT 06248
Phone (860) 228-3888

512 Saybrook Rd
Ste 100
Middletown, CT 06457
Phone (860) 704-6021

430 Saybrook Rd
Middletown, CT 06457
Phone (860) 638-3820

4 Grove Beach Rd N
Ste Ef
Westbrook, CT 06498

4 Grove Beach Rd N
Ste E
Westbrook, CT 06498

Interoperability endpoints

  • Direct secure messaging: mfernandez@ons.emadirect.md

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 7

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": "1205193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582761600000",
    "number": "1205006822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 SAYBROOK RD STE 100",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064574780",
            "telephone_number": "860-685-8940",
            "fax_number": "860-685-8944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 SAYBROOK RD STE 100",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064574780",
            "telephone_number": "860-685-8940",
            "fax_number": "860-685-8944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "MATTHEW",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-11",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CT",
            "license": "002064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, CT

Sources for this page

Verify at the official NPI Registry.