Matthew Kanelos, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601007022 Issued in MI

Practice address

11307 N Linden Rd
B
Clio, MI 48420

Phone

(810) 564-7995

NPI assigned

Jul 16, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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 1

Specialty

Physician Assistant

Education

Wayne State University School of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Springfield Urgent Care PLLCGroup PAC ID 3971869942, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Interoperability endpoints

• Direct secure messaging: matthew.kanelos.1@31854.direct.athenahealth.com

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.

• Springfield Urgent Care, P.L.L.C.

  • Urgent Care Clinic/Center
  • Clarkston, MI
  • NPI 1144747460
  Medicare reassignment Care Compare group
• Amd Urgent Medical Care, PLLC

  • Urgent Care Clinic/Center
  • Clio, MI
  • NPI 1184968679
  Medicare reassignment
• Ppsmg Urgent Medical Care, PLLC

  • Urgent Care Clinic/Center
  • Swartz Creek, MI
  • NPI 1750704680
  Medicare reassignment
• Amd Primary Care, PLLC

  • Family Medicine Physician
  • Swartz Creek, MI
  • NPI 1568858504
  NPD (past)

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

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405468800000",
    "number": "1770990335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11307 N LINDEN RD",
            "address_2": "B",
            "city": "CLIO",
            "state": "MI",
            "postal_code": "48420",
            "telephone_number": "810-564-7995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11307 N LINDEN RD",
            "address_2": "B",
            "city": "CLIO",
            "state": "MI",
            "postal_code": "48420",
            "telephone_number": "810-564-7995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANELOS",
        "first_name": "MATTHEW",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-16",
        "last_updated": "2014-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Anne Jarrett, DPT
• Deanna Lynn Jenkinson
• Carrie Johnson
• Amber Jones
• Anu Joseph
• Edwin Richard Kaput, D.C.
• Alexander Francis Keinath, DPT
• Kindred Spirit
• Kindred Spirit
• Joshua Adam Klamert, RRT

• Physician Assistant in Clio, MI
• Providers in Clio, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.