Individual provider Active NPI

Matthew James Procaccini, PA

  • Medical Physician Assistant
  • Staten Island, NY
National Provider Identifier
1801043914
Registry record updated Mar 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
6015 Issued in CT
Practice address
475 Seaview Ave
Staten Island, NY 10305
Phone
(718) 226-9158
Fax
(718) 226-6964
NPI assigned
Aug 20, 2008
Last updated
Mar 23, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 013719 NY
Medical Physician Assistant 363AM0700X 6015 CT Primary

Addresses

Primary practice location

475 Seaview Ave
Staten Island, NY 10305

Mailing address

One Edgewater Street
Staten Island, NY 10305
Phone (718) 226-1013

Other practice location 1

385 W Main St
Avon, CT 06001-4357
Phone (860) 777-1280

Other identifiers 1

IdentifierTypeStateIssuer
03183557MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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

Enrollment IDStateProvider typePAC IDDetails
I20230330002321 CT Practitioner - Physician Assistant 1254467491 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hartford Healthcare Urgent Care Centers LLCGroup PAC ID 7618242777, 201 clinicians

Practice addresses (Care Compare)

1008 S Main St
Cheshire, CT 06410-3420
Phone (475) 244-6051

1025 Silas Deane Hwy
Wethersfield, CT 06109-4223
Phone (860) 696-2400

1215 Farmington Ave
Bristol, CT 06010-4703
Phone (860) 516-5931

1445 New Britain Ave
West Hartford, CT 06110-1659
Phone (860) 317-9787

175 Webster Square Rd
Berlin, CT 06037-2328
Phone (860) 200-8095

28 Shunpike Rd
Cromwell, CT 06416-2454
Phone (860) 613-5630

336 N Main St
West Hartford, CT 06117-2675
Phone (860) 200-7701

385 W Main St
Avon, CT 06001-4357
Phone (860) 777-6977

40 Fenn Rd
Newington, CT 06111-2212
Phone (860) 777-1283

54 Hazard Ave
Enfield, CT 06082-3845
Phone (860) 787-5780

752 Washington St
Middletown, CT 06457-2904
Phone (860) 613-5377

775 Queen St
Southington, CT 06489-1531
Phone (860) 777-1281

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.78 of 100Reported as group
Quality
85.61
Promoting interoperability
100
Improvement activities
40
Cost
46.45

National Provider Directory

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

Organizations & group practices 1

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 2

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": "1219190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679529600000",
    "number": "1801043914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE EDGEWATER STREET",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10305",
            "telephone_number": "718-226-1013",
            "fax_number": "718-226-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10305",
            "telephone_number": "718-226-9158",
            "fax_number": "718-226-6964"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "385 W Main St",
            "address_purpose": "LOCATION",
            "city": "Avon",
            "state": "CT",
            "postal_code": "060014357",
            "country_code": "US",
            "telephone_number": "860-777-1280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROCACCINI",
        "first_name": "MATTHEW",
        "middle_name": "JAMES",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-20",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "013719",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "6015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03183557",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.