NPIMap

Individual provider Active NPI

Matthew Brent Callen, PA

  • Physician Assistant
  • Saint Louis, MO
National Provider Identifier
1497762793
Registry record updated Jul 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2004002147 Issued in MO
Practice address
1 Childrens PL
Suite 4E
Saint Louis, MO 63110-1002
Phone
(314) 454-2810
Fax
(314) 454-2818
NPI assigned
Aug 1, 2006
Last updated
Jul 15, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2004002147 MO Primary

Addresses

Primary practice location

1 Childrens PL
Suite 4E
Saint Louis, MO 63110-1002

Mailing address

7425 Forsyth
C B 8221
Saint Louis, MO 63105-2161
Phone (314) 454-2810

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20040617000192 MO Practitioner - Physician Assistant 5496739344 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, 1,121 clinicians

Practice addresses (Care Compare)

1235 E Cherokee St
Springfield, MO 65804-2203

2115 S Fremont Ave
3050 MC Infectious Disease Whiteside
Springfield, MO 65804-2236
Phone (417) 820-3905

3050 E River Bluff Blvd
MC Orthopedics
Ozark, MO 65721-8807
Phone (417) 820-5610

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2004002147MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Springfield CurrentSince Aug 1, 2016 Accepting new patients
Mercy Hospital Springfield CurrentSince Aug 1, 2016 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Oct 1, 2008 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Oct 1, 2008 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

9735 Landmark Parkway Dr
Saint Louis, MO 63127
Phone (314) 842-6223

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

1965 S Fremont Ave
Ste 230
Springfield, MO 65804
Phone (417) 820-3809

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

620 S Glenstone Ave
Springfield, MO 65802
Phone (417) 829-4215

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216080000000",
    "number": "1497762793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7425 FORSYTH",
            "address_2": "C B 8221",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631052161",
            "telephone_number": "314-454-2810",
            "fax_number": "314-454-2818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PL",
            "address_2": "SUITE 4E",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101002",
            "telephone_number": "314-454-2810",
            "fax_number": "314-454-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLEN",
        "first_name": "MATTHEW",
        "middle_name": "BRENT",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2008-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2004002147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.