Matthew G. Datlow, MSPAS, PA-C
Individual provider Active NPI Physician Assistant · Oracle, AZ
NPI 1477024503 · NPPES record last updated Jun 28, 2023
Key facts
- NPI
- 1477024503
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 1040 W American Ave
Oracle, AZ 85623-6089 - Phone
- (520) 896-2092
- NPI assigned
- Dec 16, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 15
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sun Life Family Health Center Inc
Practice addresses (Care Compare)
10032 E Southern Ave
Mesa, AZ 85209-2759
Phone (480) 351-2850
1040 W American Ave
Oracle, AZ 85623-6089
Phone (520) 896-2092
174 W Hwy 287
Florence, AZ 85132-8170
Phone (520) 868-5811
865 N Arizola Rd
Casa Grande, AZ 85122-6011
Phone (520) 836-3446
Hospital & facility affiliations
- Bayada Home Health Care, Inc
- Oro Valley Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190308000714 | AZ | Practitioner - Physician Assistant | 3779822705 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sun Life Family Health Center, Inc. | Current | Accepting new patients | |
| Sun Life Family Health Center, Inc | Current |
Accepting new patients | |
| Sun Life Family Health Center, Inc. | Current |
Accepting new patients | |
| Sun Life Family Health Center, Inc. | Current | Accepting new patients | |
| Banner-University Medical Group | Past | Accepting new patients | |
| Sun Life Family Health Center, Inc | Past | Accepting new patients |
Locations
1856 E Florence Blvd
Casa Grande, AZ 85122
Phone (520) 381-0380
865 N Arizola Rd
Casa Grande, AZ 85122
Phone (520) 381-0363
655 S Dobson Rd
Ste 201
Chandler, AZ 85224
Phone (480) 307-9471
205 N Stuart Blvd
Eloy, AZ 85131
Phone (520) 466-7883
174 W Highway 287
Florence, AZ 85132
Phone (520) 868-5811
1040 W American Ave
Oracle, AZ 85623
Phone (520) 252-4707
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
1040 W American Ave
Oracle, AZ 85623-6089
Mailing address
PO Box 10097
Casa Grande, AZ 85130-0020
Phone (520) 836-3446
Other practice location 1
1358 W Orange Grove Rd
Tucson, AZ 85704-2901
Phone (520) 575-1272
Other practice location 2
12560 N Blondin Dr
Marana, AZ 85653-8075
Phone (805) 732-4261
Other practice location 3
1701 W Saint Marys Rd Ste 100
Tucson, AZ 85745-2621
Phone (520) 276-2270
Other providers in Oracle, AZ
- Anthony Benavidez
- William Maurice Bunch
- Kira Lynn Cornett
- Sarah L Daffron
- Daniel Mark Gust
- Horizon Health & Wellness, Inc.
- Horizon Health and Wellness, Inc.
- John Paul Huntington
- Melinda Amy Hutton
All providers in Oracle, AZ · Physician Assistant in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.