Individual provider Active NPI

Matthew Tyler Klock, PA-C

  • Medical Physician Assistant
  • Seattle, WA
National Provider Identifier
1740812791
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MK8734875 Issued in WA
Practice address
1100 9TH Ave
Seattle, WA 98101-2756
Phone
(206) 624-1144
NPI assigned
Feb 7, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA061315 PA
Medical Physician Assistant 363AM0700X MA061315 PA
Medical Physician Assistant 363AM0700X MK8734875 WA Primary

Addresses

Primary practice location

1100 9TH Ave
Seattle, WA 98101-2756

Mailing address

PO Box 741515
Los Angeles, CA 90074-1515
Phone (206) 515-5811

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NV, WA3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20200303000656 PA Practitioner - Physician Assistant 5597192609 Reassigns benefits to 1 organization
I20221005001874 NV Practitioner - Physician Assistant 5597192609 Reassigns benefits to 2 organizations
I20240421000117 WA Practitioner - Physician Assistant 5597192609 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Virginia Mason Medical CenterGroup PAC ID 9830002617, 867 clinicians

Practice addresses (Care Compare)

1100 9TH Ave
Seattle, WA 98101-2756
Phone (206) 223-6600

19116 33Rd Ave W
Lynnwood, WA 98036-4706
Phone (425) 712-7900

33501 1St Way S
Federal Way, WA 98003-6208
Phone (253) 838-2400

620 5TH Ave S
Suite 200
Kirkland, WA 98033-6736
Phone (425) 814-5100

925 Seneca St
Seattle, WA 98101-2742
Phone (206) 223-6600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA061315PAMDPhysician Assistant
MK8734875WAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic CurrentSince Apr 13, 2020 Accepting new patients
Virginia Mason Medical Center CurrentSince Apr 24, 2024 Accepting new patients
Geisinger Clinic CurrentSince Apr 13, 2020 Accepting new patients
Virginia Mason Medical Center CurrentSince Apr 24, 2024 Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

380 Winslow Way E
Bainbridge Island, WA 98110
Phone (206) 842-5632

925 Seneca St
Seattle, WA 98101
Phone (206) 341-0860

1100 9th Ave
Seattle, WA 98101
Phone (206) 223-6980

Organizations & group practices 8

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1581033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1740812791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741515",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900741515",
            "telephone_number": "206-515-5811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 9TH AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981012756",
            "telephone_number": "206-624-1144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOCK",
        "first_name": "MATTHEW",
        "middle_name": "TYLER",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-07",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA061315",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA061315",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "MK8734875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.