Individual provider Active NPI

Matthew Vennell

  • Medical Physician Assistant
  • Richmond, VA
National Provider Identifier
1679971410
Registry record updated Dec 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
7101 Jahnke Rd
Richmond, VA 23225-4017
Phone
(804) 320-3911
NPI assigned
Dec 10, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

7101 Jahnke Rd
Richmond, VA 23225-4017

Mailing address

5005 Westwind Dr
Myrtle Beach, SC 29579-1846

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150428001618 VA Practitioner - Physician Assistant 4385963255 Reassigns benefits to 2 organizations
I20221004000688 FL Practitioner - Physician Assistant 4385963255 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Carbon Health Medical Group of Florida PA CurrentSince Sep 12, 2022 Accepting new patients
Carbon Health Medical Group of Florida PA CurrentSince Sep 12, 2022 Accepting new patients

Locations

2920 Telegraph Ave
Ste 100
Berkeley, CA 94705
Phone (415) 549-0212

8931 W Atlantic Blvd
Coral Springs, FL 33071
Phone (754) 225-7033

4825 SW 148th Ave
Davie, FL 33330
Phone (954) 526-7291

915 W 49th St
Hialeah, FL 33012
Phone (305) 200-1225

Organizations & group practices 5

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": "1418169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418169600000",
    "number": "1679971410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5005 WESTWIND DR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295791846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7101 JAHNKE RD",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232254017",
            "telephone_number": "804-320-3911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENNELL",
        "first_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-10",
        "last_updated": "2014-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.