Individual provider Active NPI

Matthew Okane, PA-C

  • Physician Assistant
  • Peoria, AZ
National Provider Identifier
1568765758
Registry record updated Feb 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4794 Issued in AZ
Practice address
9179 W Thunderbird Rd Ste B105
Peoria, AZ 85381-4875
Phone
(623) 815-9733
Fax
(623) 815-9755
NPI assigned
Dec 10, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2019

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 4794 AZ Primary

Addresses

Primary practice location

9179 W Thunderbird Rd Ste B105
Peoria, AZ 85381-4875

Mailing address

9179 W Thunderbird Rd Ste B105
Peoria, AZ 85381-4875
Phone (623) 815-9733

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110125000014 AZ Practitioner - Physician Assistant 4587602503 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sun Cities Medical Group PCGroup PAC ID 3173517141, 4 clinicians

Practice addresses (Care Compare)

9179 W Thunderbird Rd
Peoria, AZ 85381-4875
Phone (623) 815-9733

National Provider Directory

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

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1291939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548979200000",
    "number": "1568765758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9179 W THUNDERBIRD RD STE B105",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814875",
            "telephone_number": "623-815-9733",
            "fax_number": "623-815-9755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9179 W THUNDERBIRD RD STE B105",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814875",
            "telephone_number": "623-815-9733",
            "fax_number": "623-815-9755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKANE",
        "first_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-10",
        "last_updated": "2019-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "4794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

Verify at the official NPI Registry.