Matthew David Hicks, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

CO1400 Issued in AR

Practice address

1200 W Walnut St
Rogers, AR 72756-3546

Phone

(479) 636-0200

Fax

(479) 936-2912

NPI assigned

Mar 27, 2006

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 2

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pinnacle Anesthesia Group PLLCGroup PAC ID 9537514385, 14 clinicians

Orthomed Staffing LLCGroup PAC ID 9638429178, 373 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

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 and National Provider Directory roles.

• Pinnacle Anesthesia Group, PLLC

  • Anesthesiology Physician
  • Rogers, AR
  • NPI 1487358941
  Medicare reassignment Care Compare group NPD
• Orthomed Staffing LLC

  • Anesthesiology Physician
  • Addison, TX
  • NPI 1225514276

  AR

  Medicare reassignment Care Compare group NPD
• Taylor Surgery Center, LLC

  • Anesthesiology Physician
  • Fayetteville, AR
  • NPI 1740738897
  Medicare reassignment NPD
• Anesthesia Services of Benton County PA

  • Anesthesiology Physician
  • Rogers, AR
  • NPI 1013084482
  NPD (past)
• Omh Home Health

  • Home Health Agency
  • Okmulgee, OK
  • NPI 1831191543
  NPD (past)

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196899200000",
    "number": "1316907959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 507",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727450507",
            "telephone_number": "816-461-8288",
            "fax_number": "816-461-6586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W WALNUT ST",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727563546",
            "telephone_number": "479-636-0200",
            "fax_number": "479-936-2912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-27",
        "last_updated": "2007-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "CO1400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "919212001",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150123701",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Herzig, M.A.,CCC-SLP
• Mark Alan Hewett, M.D.
• Jillian Lorraine Hewlett, APRN
• Jennette Hibbs, PT, DPT
• Sarah Elizabeth Hickam
• Sydney Hope High
• Highlands of Rogers Dixieland Holdings LLC
• Highlands of Rogers Dixieland, LLC
• Highlands of Rogers, LLC
• Highlands Oncology Group PA

• Certified Registered Nurse Anesthetist in Rogers, AR
• Providers in Rogers, AR by specialty
• Certified Registered Nurse Anesthetist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.