Active NPI
Matthew James Procaccini, PA
- Medical Physician Assistant
- Staten Island, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 6015
- 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, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03183557 | Medicaid | NY |
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
Enrollment records 1
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
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 100
- 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.
-
- Urgent Care Clinic/Center
- Avon, CT
- NPI 1093239683
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Hartford, CT
- NPI 1770696643
-
- General Acute Care Hospital
- Hartford, CT
- NPI 1902834880
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; 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.