Individual provider Active NPI

Matthew Meyer, MSN

  • Emergency Registered Nurse
  • Leesburg, FL
National Provider Identifier
1396267753
Registry record updated Oct 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Registered NurseTaxonomy code 163WE0003X
License
RN9293663 Issued in FL
Practice address
600 E Dixie Ave
Leesburg, FL 34748-5925
Phone
(352) 323-5200
NPI assigned
Jul 7, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Registered Nurse 163WE0003X RN9293663 FL Primary

Addresses

Primary practice location

600 E Dixie Ave
Leesburg, FL 34748-5925

Mailing address

539 Rolling Acres Rd
Lady Lake, FL 32159-5035
Phone (352) 988-4115

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
I20171205000850 FL Practitioner - Nurse Practitioner 4183981822 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Surgical Practice Resource Group of Florida IncGroup PAC ID 5496030819, 2 clinicians
Paragon Emergency Services LLCGroup PAC ID 8628153087, 401 clinicians

Practice addresses (Care Compare)

539 Rolling Acres Rd
Lady Lake, FL 32159-5035
Phone (727) 439-8667

600 E Dixie Ave
Leesburg, FL 34748-5925
Phone (352) 323-5762

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN9293663FLMDEmergency Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Surgical Practice Resource Group of Florida Inc CurrentSince Jul 8, 2020 Accepting new patients

Locations

201 W Guava St
Lady Lake, FL 32159
Phone (352) 391-5875

539 Rolling Acres Rd
Lady Lake, FL 32159
Phone (352) 456-0220

600 E Dixie Ave
Leesburg, FL 34748
Phone (352) 323-5090

1451 El Camino Real
The Villages, FL 32159
Phone (352) 751-8000

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.

NPI Registry JSON

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

{
    "created_epoch": "1499385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1396267753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "539 ROLLING ACRES RD",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321595035",
            "telephone_number": "352-988-4115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E DIXIE AVE",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485925",
            "telephone_number": "352-323-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEYER",
        "first_name": "MATTHEW",
        "credential": "MSN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-07",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "FL",
            "license": "RN9293663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, FL

Sources for this page

Verify at the official NPI Registry.