Individual provider Active NPI

Matthew Anton

  • Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1609698869
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71015899A Issued in IN
Practice address
8075 N Shadeland Ave Ste 350
Indianapolis, IN 46250-2693
Phone
(317) 621-8668
Fax
(317) 621-8571
NPI assigned
Oct 29, 2024
Last updated
Apr 4, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71015899A IN Primary

Addresses

Primary practice location

8075 N Shadeland Ave Ste 350
Indianapolis, IN 46250-2693

Mailing address

10736 Springston CT
Fishers, IN 46037

Other practice location 1

8075 N Shadeland Ave
Indianapolis, IN 46250
Phone (317) 621-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20241118002314 IN Practitioner - Nurse Practitioner 6901330687 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
71015899AINMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physicians of Indiana Inc CurrentSince Dec 9, 2024 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Dec 9, 2024 Accepting new patients

Locations

5819 Reliable Pkwy
Chicago, IL 60686

6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

8075 N Shadeland Ave
Indianapolis, IN 46250
Phone (317) 621-8000

8075 N Shadeland Ave
Ste 350
Indianapolis, IN 46250
Phone (317) 621-8668

Interoperability endpoints

  • Direct secure messaging: manton631475@ecommunitydirect.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1730160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743724800000",
    "number": "1609698869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10736 SPRINGSTON CT",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "46037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8075 N SHADELAND AVE STE 350",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502693",
            "telephone_number": "317-621-8668",
            "fax_number": "317-621-8571"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8075 N Shadeland Ave",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "46250",
            "country_code": "US",
            "telephone_number": "317-621-8000",
            "fax_number": "317-621-8571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANTON",
        "first_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-29",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71015899A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.