Individual provider Active NPI

Matthew C Aoun, PA-C

  • Physician Assistant
  • Albany, NY
National Provider Identifier
1366895641
Registry record updated Dec 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
019898 Issued in NY
Practice address
23 Hackett Blvd
Albany, NY 12208-3436
Phone
(518) 262-3341
Fax
(518) 262-6660
NPI assigned
Jul 21, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2016

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 019898 NY Primary

Addresses

Primary practice location

23 Hackett Blvd
Albany, NY 12208-3436

Mailing address

711 Troy Schenectady Rd
Suite 203
Latham, NY 12110-2442
Phone (518) 782-3700

Other identifiers 1

IdentifierTypeStateIssuer
04545180MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20160927001607 NY Practitioner - Physician Assistant 7012204589 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
019898NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Albany Medical College Physician Assistant Current Accepting new patients
Albany Medical College Physician Assistant Current Accepting new patients
Albany Medical College Physician Assistant Current Accepting new patients
Albany Medical College CurrentSince May 1, 2017 Accepting new patients
Albany Medical College Physician Assistant CurrentSince May 1, 2017 Accepting new patients

Locations

47 New Scotland Ave
#61
Albany, NY 12208
Phone (518) 262-5791

23 Hackett Blvd
Albany, NY 12208
Phone (518) 262-3296

47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1469059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480982400000",
    "number": "1366895641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD",
            "address_2": "SUITE 203",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102442",
            "telephone_number": "518-782-3700",
            "fax_number": "518-782-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 HACKETT BLVD",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122083436",
            "telephone_number": "518-262-3341",
            "fax_number": "518-262-6660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AOUN",
        "first_name": "MATTHEW",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-21",
        "last_updated": "2016-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "019898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04545180",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.