NPIMap

Individual provider Active NPI

Michael Mathson, P.A.

  • Physician Assistant
  • Kingsport, TN
National Provider Identifier
1437347606
Registry record updated Jul 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1537 Issued in TN
Practice address
130 W. Ravine Rd.
Kingsport, TN 37660
Phone
(423) 224-3450
Fax
(423) 224-3458
NPI assigned
Oct 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1537 TN Primary
Emergency Medicine Physician 207P00000X 1537 TN

Addresses

Primary practice location

130 W. Ravine Rd.
Kingsport, TN 37660

Mailing address

119 Boone Ridge Drive
Suite 201
Johnson City, TN 37615
Phone (423) 282-1480

Other identifiers 1

IdentifierTypeStateIssuer
1516958MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130820000959 FL Practitioner - Physician Assistant 5698863801 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Indian River Health Services IncGroup PAC ID 9234130329, 335 clinicians

Practice addresses (Care Compare)

1000 36TH St
Vero Beach, FL 32960-4862
Phone (772) 567-4311

1190 37TH St
Vero Beach, FL 32960-6507
Phone (772) 567-4311

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Indian River Health Services Inc CurrentSince Aug 25, 2025 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Oct 13, 2022 Accepting new patients
Indian River Health Services Inc CurrentSince Aug 25, 2025 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Oct 13, 2022 Accepting new patients
Inpatient Consultants of Tennessee, P.C. Physician Assistant Past Accepting new patients
Lake Mary Medical Consulting Inc Emergency Medicine Past Accepting new patients
Johnson City Emergency Physicians, PC Emergency Medicine Past Accepting new patients

Locations

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

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

1190 37th St
Vero Beach, FL 32960
Phone (772) 563-4666

1000 36th St
Vero Beach, FL 32960
Phone (772) 567-1942

6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 11

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": "1192147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311206400000",
    "number": "1437347606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 BOONE RIDGE DRIVE",
            "address_2": "SUITE 201",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37615",
            "telephone_number": "423-282-1480",
            "fax_number": "423-928-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W. RAVINE RD.",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "37660",
            "telephone_number": "423-224-3450",
            "fax_number": "423-224-3458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHSON",
        "first_name": "MICHAEL",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-12",
        "last_updated": "2011-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "1537",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "1537",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1516958",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.