Individual provider Active NPI

A Matthew Brunner, PA-C

  • Physician Assistant
  • Stockbridge, GA
National Provider Identifier
1811993223
Registry record updated Apr 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
003575 Issued in GA
Practice address
210 Village Center Pkwy
Stockbridge, GA 30281-9044
Phone
(770) 474-5952
Fax
(770) 474-1300
NPI assigned
Jun 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2026

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 003575 GA Primary

Addresses

Primary practice location

210 Village Center Pkwy
Stockbridge, GA 30281-9044

Mailing address

210 Village Center Pkwy
Stockbridge, GA 30281-9044
Phone (770) 474-5952

Other identifiers 1

IdentifierTypeStateIssuer
6535OtherGAKAISER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20101116000481 GA Practitioner - Physician Assistant 3274728217 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of South Alabama College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dermatology and Skin Surgery Center. P.C.Group PAC ID 5193625945, 10 clinicians

Practice addresses (Care Compare)

210 Village Ctr Pkwy
Stockbridge, GA 30281-9044
Phone (770) 474-5952

Merit-based Incentive Payment System (MIPS)

Final score
94.61 of 100Reported as group
Quality
89.22
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
003575GAMDPhysician 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776988800000",
    "number": "1811993223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 VILLAGE CENTER PKWY",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819044",
            "telephone_number": "770-474-5952",
            "fax_number": "770-474-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 VILLAGE CENTER PKWY",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819044",
            "telephone_number": "770-474-5952",
            "fax_number": "770-474-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNNER",
        "first_name": "A",
        "middle_name": "MATTHEW",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2026-04-24",
        "certification_date": "2026-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "003575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER",
            "identifier": "6535",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

Verify at the official NPI Registry.