Active NPI
Matthew Gregory Prohaska, D.O.
- Family Medicine Physician
- Collettsville, NC
National Provider Identifier
1679528400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 024859
- Practice address
- 4330 Collettsville Rd
Collettsville, NC 28611-9000 - Phone
- (828) 754-2409
- Fax
- (828) 754-2418
- NPI assigned
- May 23, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 024859 | GA | Primary |
| Family Medicine Physician | 207Q00000X | 2016-02370 | NC |
Addresses
Primary practice location
4330 Collettsville Rd
Collettsville, NC 28611-9000
Mailing address
4330 Collettsville Rd
Collettsville, NC 28611-9000
Phone (828) 754-2409
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
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2016-02370 | NC | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McKinney Community Health Ctr, Inc | Past | Accepting new patients | |
| Mayo Clinic Health System in Waycross, Inc. | Past | Accepting new patients |
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.
-
- Multi-Specialty Clinic/Center
- Waycross, GA
- NPI 1154745982
-
- Federally Qualified Health Center (FQHC)
- Blackshear, GA
- NPI 1568623346
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481760000000",
"number": "1679528400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4330 COLLETTSVILLE RD",
"city": "COLLETTSVILLE",
"state": "NC",
"postal_code": "286119000",
"telephone_number": "828-754-2409",
"fax_number": "828-754-2418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4330 COLLETTSVILLE RD",
"city": "COLLETTSVILLE",
"state": "NC",
"postal_code": "286119000",
"telephone_number": "828-754-2409",
"fax_number": "828-754-2418"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROHASKA",
"first_name": "MATTHEW",
"middle_name": "GREGORY",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-23",
"last_updated": "2016-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "024859",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NC",
"license": "2016-02370",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Collettsville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.