Active NPI
Shane Ashley Matthews, PA
- Physician Assistant
- Fort Collins, CO
National Provider Identifier
1558631002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 3370
- Practice address
- 2121 E Harmony Rd
Ste 100
Fort Collins, CO 80528-3400 - Phone
- (970) 221-1000
- Fax
- (970) 297-6860
- NPI assigned
- Dec 30, 2011
- 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 | 3370 | CO | Primary |
Addresses
Primary practice location
2121 E Harmony Rd
Ste 100
Fort Collins, CO 80528-3400
Mailing address
2121 E Harmony Rd
Suite 100
Fort Collins, CO 80528-3400
Phone (970) 221-1000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05505810 | Medicaid | CO |
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)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402531200000",
"number": "1558631002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2121 E HARMONY RD",
"address_2": "SUITE 100",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805283400",
"telephone_number": "970-221-1000",
"fax_number": "970-297-6860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 E HARMONY RD",
"address_2": "STE 100",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805283400",
"telephone_number": "970-221-1000",
"fax_number": "970-297-6860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTHEWS",
"first_name": "SHANE",
"middle_name": "ASHLEY",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-12-30",
"last_updated": "2014-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "3370",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "05505810",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.