NPIMap

Individual provider Active NPI

Matt Douglas, P.A.

  • Physician Assistant
  • Hutchinson, KS
National Provider Identifier
1750354643
Registry record updated Sep 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15-00848 Issued in KS
Practice address
2101 N Waldron St
Hutchinson, KS 67502-1131
Phone
(620) 669-2500
Fax
(620) 694-4225
NPI assigned
Feb 10, 2006
Last updated
Sep 18, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 15-00848 KS Primary

Addresses

Primary practice location

2101 N Waldron St
Hutchinson, KS 67502-1131

Mailing address

2101 N Waldron St
Hutchinson, KS 67502-1131
Phone (620) 669-2500

Other identifiers 1

IdentifierTypeStateIssuer
100425400AMedicaidKS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mattdouglas@hcpa.allscriptsdirect.net Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050531000585 KS Practitioner - Physician Assistant 8325080344 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hutchinson Clinic PA IncGroup PAC ID 5597658492, 130 clinicians

Practice addresses (Care Compare)

1604 Aylward Ave
Ellsworth, KS 67439-2541
Phone (785) 472-3111

2101 N Waldron St
Hutchinson, KS 67502-1131
Phone (620) 669-2500

2107 N Waldron St
Hutchinson, KS 67502-1131
Phone (620) 669-2500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15-00848KSMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Heartland Radiation Oncology Current Accepting new patients
Reno Pathology Associates, LLC Current Accepting new patients
Hutchinson Clinic, P.a., Inc. Current Accepting new patients
Hutchinson Clinic, PA, Inc. CurrentSince Aug 8, 2002 Accepting new patients
Hutchinson Regional Medical Center, Inc. CurrentSince Jul 1, 2015 Accepting new patients
Hutchinson Clinic, P.a. Inc. Current Accepting new patients
Hutchinson Clinic, P.a., Inc. Current Accepting new patients

Locations

1701 E 23rd Ave
Hutchinson, KS 67502
Phone (620) 665-2117

2101 N Waldron St
Hutchinson, KS 67502
Phone (620) 669-2500

Organizations & group practices 9

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.

Hospital & facility affiliations 5

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": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1750354643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 N WALDRON ST",
            "city": "HUTCHINSON",
            "state": "KS",
            "postal_code": "675021131",
            "telephone_number": "620-669-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 N WALDRON ST",
            "city": "HUTCHINSON",
            "state": "KS",
            "postal_code": "675021131",
            "telephone_number": "620-669-2500",
            "fax_number": "620-694-4225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "MATT",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-00848",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100425400A",
            "state": "KS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mattdouglas@hcpa.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Hutchinson Clinic, PA",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CCDA",
            "address_1": "2101 N Waldron St",
            "city": "Hutchinson",
            "state": "KS",
            "country_code": "US",
            "postal_code": "675021131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hutchinson, KS

Sources for this page

Verify at the official NPI Registry.