Individual provider Active NPI

Matthew D Miller, PA-C

  • Surgical Physician Assistant
  • Fort Lauderdale, FL
National Provider Identifier
1366087082
Registry record updated Aug 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA9116836 Issued in FL
Practice address
1995 E Oakland Park Blvd Ste 310
Fort Lauderdale, FL 33306-1138
Phone
(954) 791-6146
NPI assigned
Nov 18, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00560200 NJ
Physician Assistant 363A00000X PA9116836 FL
Physician Assistant 363A00000X 024326 NY
Surgical Physician Assistant 363AS0400X PA9116836 FL Primary

Addresses

Primary practice location

1995 E Oakland Park Blvd Ste 310
Fort Lauderdale, FL 33306-1138

Mailing address

PO Box 936535
Atlanta, GA 31193-6535

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20230523003505 FL Practitioner - Physician Assistant 2567828197 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Practitioners, LLCGroup PAC ID 1658688304, 63 clinicians

Practice addresses (Care Compare)

1000 NE 56TH St
Fort Lauderdale, FL 33334-4149
Phone (954) 229-8635

3501 Johnson St
Hollywood, FL 33021-5421
Phone (954) 987-2000

3600 Washington St
Hollywood, FL 33021-8216
Phone (954) 966-4500

Hospital & facility affiliations

  • Memorial Regional Hospital Hospital, Hollywood, FL, CCN 100038

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
024326NYMDClinical Psychologist
25MP00560200NJMDPhysician Assistant
PA9116836FLMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Galileo Technologies LLC PastSince Mar 7, 2021 Accepting new patients

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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": "1574035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1366087082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936535",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1995 E OAKLAND PARK BLVD STE 310",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333061138",
            "telephone_number": "954-791-6146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "MATTHEW",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-18",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00560200",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116836",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "024326",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9116836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.