Active NPI
Matthew Daniel Powellson, M.D.
- Internal Medicine Physician
- Statesboro, GA
National Provider Identifier
1336345487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 066402
- Practice address
- 1310 Brampton Ave
Statesboro, GA 30458-0851 - Phone
- (912) 486-1873
- Fax
- (912) 486-2394
- NPI assigned
- Jun 25, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 066402 | GA | |
| Internal Medicine Physician | 207R00000X | 066402 | GA | Primary |
Addresses
Primary practice location
1310 Brampton Ave
Statesboro, GA 30458-0851
Mailing address
1449 Brampton Ave
Statesboro, GA 30458-0854
Phone (912) 871-2900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Pediatric Medicine
- Education
- Indiana University School of Medicine, 2007
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
1055 Evergreen Cir
The Woodlands, TX 77380-3602
Phone (281) 363-3560
Hospital & facility affiliations
- Memorial Hermann Hospital System
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woodlands Family Practice P.a. | Current | Accepting new patients | |
| Wrightsboro Inpatient Services | Internal Medicine | Past | Accepting new patients |
| East Georgia Hma Physician Management, LLC | Internal Medicine | Past | Accepting new patients |
Locations
1055 Evergreen Cir
The Woodlands, TX 77380
Phone (281) 363-3560
Interoperability endpoints
- mpowellson66567@memorialhermann.direct-ci.com
Organizations & group practices 3
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.
-
- Family Medicine Physician
- The Woodlands, TX
- NPI 1033230602
-
- Internal Medicine Physician
- Statesboro, GA
- NPI 1487983151
-
- Internal Medicine Physician
- Augusta, GA
- NPI 1659514925
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Houston, TX
- NPI 1730132234
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409011200000",
"number": "1336345487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1449 BRAMPTON AVE",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304580854",
"telephone_number": "912-871-2900",
"fax_number": "912-871-3901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1310 BRAMPTON AVE",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304580851",
"telephone_number": "912-486-1873",
"fax_number": "912-486-2394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWELLSON",
"first_name": "MATTHEW",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-25",
"last_updated": "2014-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "066402",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "GA",
"license": "066402",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Statesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2014; 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.
- 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.