Active NPI
Patrick Matolka, PA
- Physician Assistant
- Castleton, NY
National Provider Identifier
1487005161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 019753
- Practice address
- 35 Empire State Blvd
Castleton, NY 12033-9777 - Phone
- (518) 477-2167
- Fax
- (518) 477-5182
- NPI assigned
- Jun 24, 2016
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 019753 | NY | Primary |
Addresses
Primary practice location
35 Empire State Blvd
Castleton, NY 12033-9777
Mailing address
711 Troy Schenectady Rd
Suite 203
Latham, NY 12110-2442
Phone (518) 783-3110
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04493041 | Medicaid | NY |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Albany Medical College of Union University, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
711 Troy Schenectady Rd
Latham, NY 12110-2461
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Latham, NY
- NPI 1922048370
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479686400000",
"number": "1487005161",
"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": "518-783-3110",
"fax_number": "518-782-3799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35 EMPIRE STATE BLVD",
"city": "CASTLETON",
"state": "NY",
"postal_code": "120339777",
"telephone_number": "518-477-2167",
"fax_number": "518-477-5182"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATOLKA",
"first_name": "PATRICK",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-24",
"last_updated": "2016-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "019753",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04493041",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Castleton, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2016; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.