NPIMap

Individual provider Active NPI

Matthew Hale, M.D.

  • Emergency Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1558411397
Registry record updated Apr 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
ME103060 Issued in FL
Practice address
655 W 8TH St
Ufjp Emergency Medicine
Jacksonville, FL 32209-6511
Phone
(904) 244-4984
NPI assigned
Jan 12, 2007
Last updated
Apr 19, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X TRN10165 FL
Emergency Medicine Physician 207P00000X ME103060 FL Primary

Addresses

Primary practice location

655 W 8TH St
Ufjp Emergency Medicine
Jacksonville, FL 32209-6511

Mailing address

PO Box 44008
Ufjp Provider Enrollment
Jacksonville, FL 32231-4008

Other identifiers 3

IdentifierTypeStateIssuer
0012042-00MedicaidFL
666994843BMedicaidGA
145NMOtherFLBCBS - FL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090804000257 FL Practitioner - Emergency Medicine 2264585520 Reassigns benefits to 2 organizations
I20180117000977 GA Practitioner - Emergency Medicine 2264585520 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of South Carolina School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acs Primary Care Physicians - Southeast PCGroup PAC ID 5193620714, 409 clinicians

Practice addresses (Care Compare)

1900 Tebeau St
Waycross, GA 31501-6357
Phone (912) 283-3030

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
98
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
TRN10165FLMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians Inc Emergency Medicine CurrentSince Jan 1, 2010 Accepting new patients
Emergency Physicians Inc Emergency Medicine CurrentSince Nov 1, 2017 Accepting new patients
University of Florida Jacksonville Physicians Inc Current Accepting new patients
Emergency Physicians Inc Emergency Medicine CurrentSince Nov 1, 2017 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Jan 1, 2010 Accepting new patients
Physicians Medical Center, Inc. Past Accepting new patients
Cobblestone Emergency Physicians Emergency Medicine Past Accepting new patients
Physicians Medical Centers-Jax Inc PastSince Sep 25, 2012 Accepting new patients
St Luke's Emergency Care Group LLC Emergency Medicine Past Accepting new patients

Locations

1250 S 18th St
Ste 202
Fernandina Beach, FL 32034
Phone (904) 202-2000

1747 Baptist Clay Dr
Ste 250
Fleming Isle, FL 32003
Phone (904) 516-1000

4201 Belfort Rd
Jacksonville, FL 32216
Phone (904) 268-5561

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

820 Prudential Dr
Ste 713
Jacksonville, FL 32207
Phone (800) 936-5996

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

400 Health Park Blvd
St Augustine, FL 32086
Phone (904) 819-4300

2415 Parkwood Dr
Brunswick, GA 31520
Phone (912) 466-4079

Organizations & group practices 10

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 4

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": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271635200000",
    "number": "1558411397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44008",
            "address_2": "UFJP PROVIDER ENROLLMENT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322314008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 W 8TH ST",
            "address_2": "UFJP EMERGENCY MEDICINE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096511",
            "telephone_number": "904-244-4984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALE",
        "first_name": "MATTHEW",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2010-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "TRN10165",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME103060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012042-00",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "666994843B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - FL",
            "identifier": "145NM",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.