Active NPI
Matthew Charles Gillen, MD
- Neonatal-Perinatal Medicine Physician
- Atlanta, GA
National Provider Identifier
1366974461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neonatal-Perinatal Medicine Physician
- License
- 88862
- Practice address
- 2015 Uppergate Drive NE 5TH Floor
Atlanta, GA 30322-3039 - Phone
- (404) 727-5765
- Fax
- (404) 727-3236
- NPI assigned
- Mar 29, 2017
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 88862 | GA | |
| Pediatrics Physician | 208000000X | 35.139244 | OH | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Neonatal-Perinatal Medicine Physician | 2080N0001X | 88862 | GA | Primary |
Addresses
Primary practice location
2015 Uppergate Drive NE 5TH Floor
Atlanta, GA 30322-3039
Mailing address
2015 Uppergate Drive NE 5TH Floor
Atlanta, GA 30322-0001
Phone (404) 727-5765
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210713000281 | GA | Order and Referring Only - Pediatric Medicine | 5496166449 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 88862 | GA | MD | Neonatal-Perinatal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720742400000",
"number": "1366974461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2015 UPPERGATE DRIVE NE 5TH FLOOR",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303220001",
"telephone_number": "404-727-5765",
"fax_number": "404-727-3236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2015 UPPERGATE DRIVE NE 5TH FLOOR",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303223039",
"telephone_number": "404-727-5765",
"fax_number": "404-727-3236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLEN",
"first_name": "MATTHEW",
"middle_name": "CHARLES",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-03-29",
"last_updated": "2024-07-12",
"certification_date": "2024-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "88862",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "35.139244",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2080N0001X",
"taxonomy_group": "",
"desc": "Pediatrics, Neonatal-Perinatal Medicine",
"state": "GA",
"license": "88862",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2024; 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.