Active NPI
Matthew Hart
- Independent Duty Corpsman
- San Diego, CA
National Provider Identifier
1508417510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Independent Duty Corpsman
- Practice address
- 3400 Bob Wilson Drive
San Diego, CA 92134-0001 - Phone
- (912) 547-4013
- NPI assigned
- Sep 23, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Independent Duty Corpsman | 1710I1002X | Primary |
Addresses
Primary practice location
3400 Bob Wilson Drive
San Diego, CA 92134-0001
Mailing address
6829 Ga Highway 17 S
Bloomingdale, GA 31302-4610
Phone (912) 547-4013
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569196800000",
"number": "1508417510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6829 GA HIGHWAY 17 S",
"city": "BLOOMINGDALE",
"state": "GA",
"postal_code": "313024610",
"telephone_number": "912-547-4013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 BOB WILSON DRIVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921340001",
"telephone_number": "912-547-4013"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HART",
"first_name": "MATTHEW",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-09-23",
"last_updated": "2019-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "1710I1002X",
"taxonomy_group": "",
"desc": "Military Health Care Provider, Independent Duty Corpsman",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.