NPIMap

Individual provider Active NPI

Matthew Brockman

  • Physician Assistant
  • Savannah, GA
National Provider Identifier
1275223604
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12284 Issued in GA
Practice address
210 E Derenne Ave
Savannah, GA 31405-6736
Phone
(912) 644-5300
Fax
(912) 644-5241
NPI assigned
May 9, 2023
Last updated
Jun 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 12284 GA Primary

Addresses

Primary practice location

210 E Derenne Ave
Savannah, GA 31405-6736

Mailing address

33 Leeward Dr
Savannah, GA 31419-9474

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240621000399 GA Practitioner - Physician Assistant 4688117468 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optim Orthopedics LLCGroup PAC ID 9931427002, 101 clinicians
Optim Orthopedics Trauma LLCGroup PAC ID 9234667510, 2 clinicians
Tattnall Hospital Company LLCGroup PAC ID 6204907124, 47 clinicians

Practice addresses (Care Compare)

101 W Mulberry Blvd
Suite 140
Savannah, GA 31407-3507
Phone (912) 748-5111

210 E Derenne Ave
Savannah, GA 31405-0000
Phone (912) 644-5300

210 E Derenne Ave
Savannah, GA 31405-6736
Phone (912) 644-5300

790 Veterans Pkwy
Suite 111
Hinesville, GA 31313-3991
Phone (912) 877-4400

810 Towne Park Dr
Suite 200
Rincon, GA 31326-5167
Phone (912) 826-2533

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Optim Orthopedics, LLC CurrentSince May 2, 2024 Accepting new patients
Tattnall Hospital Company, LLC CurrentSince May 1, 2024 Accepting new patients
Tattnall Hospital Company, LLC CurrentSince May 1, 2024 Accepting new patients
Optim Orthopedics, LLC CurrentSince May 2, 2024 Accepting new patients
Optim Orthopedics, LLC Past Accepting new patients
Tattnall Hospital Company, LLC Past Accepting new patients
Optim Orthopedics, LLC PastSince Oct 6, 2019 Accepting new patients

Locations

821 S Main St
Ste C
Baxley, GA 31513
Phone (912) 367-5486

242 Industrial Blvd
Dublin, GA 31021
Phone (478) 272-3140

790 Veterans Parkway
Ste 111
Hinesville, GA 31313
Phone (912) 368-3868

961 E Winthrope Ave
Millen, GA 30442
Phone (478) 982-0120

247 S Main St
#A
Reidsville, GA 30453
Phone (912) 352-4490

210 E Derenne Ave
Savannah, GA 31405
Phone (912) 355-0140

119B Victory Dr
Swainsboro, GA 30401
Phone (478) 237-7676

102 Rocky Ford Rd
Sylvania, GA 30467
Phone (912) 564-2155

209 Mims Rd
#A
Sylvania, GA 30467
Phone (912) 564-5236

1724 Old Reynolds St
#B
Waycross, GA 31501

Interoperability endpoints

  • Direct secure messaging: matthew.brockman.1@16403.direct.athenahealth.com

Organizations & group practices 10

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.

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": "1683590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1275223604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 LEEWARD DR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314199474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E DERENNE AVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314056736",
            "telephone_number": "912-644-5300",
            "fax_number": "912-644-5241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKMAN",
        "first_name": "MATTHEW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-09",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "12284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.