Matthew John Graham, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6551 Issued in AZ

Practice address

2741 NE McBaine Dr
Lees Summit, MO 64064-7880

Phone

(816) 554-2600

NPI assigned

May 29, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1487066106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2741 NE MCBAINE DR",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640647880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2741 NE MCBAINE DR",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640647880",
            "telephone_number": "816-554-2600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1705 W University Dr Ste 104",
            "address_purpose": "LOCATION",
            "city": "Tempe",
            "state": "AZ",
            "postal_code": "852813269",
            "country_code": "US",
            "telephone_number": "480-493-3444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "MATTHEW",
        "middle_name": "JOHN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-29",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "234246",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Scott Gordon, PHARMD
• Paula E. Gough, CRNA
• Max Rishel Gove, DO
• Jacklyn Graber, RN, BSN, MA
• Grady Orthodontics LLC
• Nicole Renee Graham, M.D.
• Noel M Graham, M.D.
• Gabrielle Granata, RBT
• Lauren Elizabeth Grant, RDN
• Anna Grashoff, AUD

• Physician Assistant in Lees Summit, MO
• Providers in Lees Summit, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.