NPIMap

Individual provider Active NPI

Matthew Neil Fuquay, PA

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1326588153
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-07113 Issued in NC
Practice address
1010 Edgehill Rd N
Charlotte, NC 28207-1885
Phone
(704) 446-1900
NPI assigned
Feb 27, 2017
Last updated
Jul 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 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 0010-07113 NC Primary

Addresses

Primary practice location

1010 Edgehill Rd N
Charlotte, NC 28207-1885

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

315 Medical Park Dr
Ste 202
Concord, NC 28025-1902
Phone (704) 403-1911

Other practice location 2

10660 Park Rd
Ste 4500
Charlotte, NC 28210-8413
Phone (704) 667-8800

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mfuquay1055041@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170606002236 NC Practitioner - Physician Assistant 0840567293 Reassigns benefits to 3 organizations
I20210923002924 SC Practitioner - Physician Assistant 0840567293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Medical CenterGroup PAC ID 4789597477, 1,057 clinicians
Carolinas Physicians Network IncGroup PAC ID 3375449655, 2,324 clinicians

Practice addresses (Care Compare)

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-2000

10628 Park Rd
Charlotte, NC 28210-8407
Phone (704) 667-1000

14214 Ballantyne Lake Rd
Charlotte, NC 28277-3373

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4089SCMDDentist
0010-07113NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center CurrentSince Oct 24, 2022 Accepting new patients
Carolinas Medical Center CurrentSince Oct 24, 2022 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Oct 24, 2022 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Sep 27, 2021 Accepting new patients
Carolinas Pathology Group, PA Current Accepting new patients
Carolinas Physicians Network Inc CurrentSince Oct 24, 2022 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Oct 24, 2022 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Oct 24, 2022 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Sep 27, 2021 Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

14214 Ballantyne Lake Rd
Ste 300
Charlotte, NC 28277
Phone (704) 446-5070

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

1010 Edgehill Rd N
Charlotte, NC 28207
Phone (704) 446-1900

10660 Park Rd
Ste 4500
Charlotte, NC 28210
Phone (704) 667-8800

200 Medical Park Dr
Ste 250
Concord, NC 28025
Phone (704) 403-2740

315 Medical Park Dr
Ste 202
Concord, NC 28025
Phone (704) 262-1911

2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

Interoperability endpoints

  • Direct secure messaging: mfuquay1055041@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 8

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": "1488153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1326588153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 EDGEHILL RD N",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071885",
            "telephone_number": "704-446-1900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 Medical Park Dr",
            "address_2": "Ste 202",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280251902",
            "country_code": "US",
            "telephone_number": "704-403-1911",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10660 Park Rd",
            "address_2": "Ste 4500",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282108413",
            "country_code": "US",
            "telephone_number": "704-667-8800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUQUAY",
        "first_name": "MATTHEW",
        "middle_name": "NEIL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-27",
        "last_updated": "2024-07-15",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-07113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mfuquay1055041@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1010 Edgehill Rd N",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282071885",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.