Matthew Christopher Wynne

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110008094 Issued in VA

Practice address

2151 Old Brick Rd
Glen Allen, VA 23060-5837

Phone

(919) 610-1014

NPI assigned

Nov 6, 2019

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

Medicare fee-for-service enrollment

Enrolled in VA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: matthew.wynne.1@18731.direct.athenahealth.com

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

{
    "created_epoch": "1572998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1356985949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2151 OLD BRICK RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230605837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 OLD BRICK RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230605837",
            "telephone_number": "919-610-1014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNNE",
        "first_name": "MATTHEW",
        "middle_name": "CHRISTOPHER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-06",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110008094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kivette Wright
• Lisa Wright, M.S. CCC-SLP
• Terry D. Wright, M.D.
• Jessica Leigh Wyant
• Ruth Overton Wyche
• Guifang Xue, L.AC, MSA, MSOM
• Nengliang Yao, PHD
• Elizabeth P Yaple, M.D.
• Deborah Patricia Yates
• Warren Hamilton Yeager Jr., R.PH.

• Medical Physician Assistant in Glen Allen, VA
• Providers in Glen Allen, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.