Individual provider Active NPI

Matthew Anthony Koeckert, RN

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
National Provider Identifier
1649706052
Registry record updated Sep 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
5671 Issued in NC
Practice address
2825 Randolph Rd
Charlotte, NC 28211-1018
Phone
(704) 377-1647
Fax
(704) 358-8267
NPI assigned
May 4, 2017
Last updated
Sep 10, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 85106 WV
Certified Registered Nurse Anesthetist 367500000X 5671 NC Primary

Addresses

Primary practice location

2825 Randolph Rd
Charlotte, NC 28211-1018

Mailing address

2080 W Arlington Blvd Ste B
Greenville, NC 27834-3770
Phone (252) 752-2140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170728000997 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 8325318009 Reassigns benefits to 1 organization
I20250724003371 SC Practitioner - Certified Registered Nurse Anesthetist (Crna) 8325318009 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Carolina Anesthesia Associates PLLCGroup PAC ID 5092720813, 691 clinicians

Practice addresses (Care Compare)

2825 Randolph Rd
Charlotte, NC 28211-1018
Phone (704) 377-1647

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Registered Nurse

State licenses

LicenseStateTypeSpecialty
5671NCMDSpeech-Language Pathologist
85106WVMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Anesthesiology Associates, P.a. Anesthesiology CurrentSince Aug 1, 2025 Accepting new patients
East Carolina Anesthesia Associates, PLLC Anesthesiology CurrentSince Jul 1, 2017 Accepting new patients

Locations

2825 Randolph Rd
Charlotte, NC 28211
Phone (704) 377-1647

3735 Glenlake Dr
Ste 250
Charlotte, NC 28208
Phone (704) 749-5801

2430 Emerald Pl
Ste 103
Greenville, NC 27834
Phone (252) 752-2140

2080 W Arlington Blvd
Ste B
Greenville, NC 27834
Phone (252) 752-2140

2536 Lengers Way
Indian Land, SC 29707
Phone (803) 313-3294

Organizations & group practices 3

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": "1493856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631232000000",
    "number": "1649706052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 W ARLINGTON BLVD STE B",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278343770",
            "telephone_number": "252-752-2140",
            "fax_number": "252-689-6502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 RANDOLPH RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111018",
            "telephone_number": "704-377-1647",
            "fax_number": "704-358-8267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOECKERT",
        "first_name": "MATTHEW",
        "middle_name": "ANTHONY",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-04",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WV",
            "license": "85106",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "5671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.