Individual provider Active NPI

Matthew Warren Hurley, M.D.

  • Family Medicine Physician
  • Rolla, MO
National Provider Identifier
1821362088
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2012012827 Issued in MO
Practice address
600 Blues Lake Pkwy
Rolla, MO 65401-8022
Phone
(573) 364-8822
Fax
(573) 341-5969
NPI assigned
Mar 5, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036.128703 IL
Family Medicine Physician 207Q00000X 2012012827 MO Primary

Addresses

Primary practice location

600 Blues Lake Pkwy
Rolla, MO 65401-8022

Mailing address

600 Blues Lake Pkwy
Rolla, MO 65401-8022
Phone (573) 364-8822

Other practice location 1

1415 W Scenic Rivers Blvd
Salem, MO 65560-2840
Phone (573) 729-5533

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120524000210 MO Practitioner - Family Practice 9830352129 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Saint Louis University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phelps County Regional Medical CenterGroup PAC ID 2860391158, shared by 7 NPIs, 111 clinicians
Pcrmc Medical Group IncGroup PAC ID 1557454063, 113 clinicians

Practice addresses (Care Compare)

1415 W Scenic Rivers Blvd
Salem, MO 65560-2840
Phone (573) 729-5533

600 Blues Lake Pkwy
Rolla, MO 65401-8022
Phone (573) 364-8822

Hospital & facility affiliations

  • Phelps Health Home Health and Hospice Home health agency, Rolla, MO, CCN 267555
  • Centerwell Home Health Home health agency, Rolla, MO, CCN 267098
  • Phelps Health Home Health and Hospice Hospice, Rolla, MO, CCN 261583
  • Phelps County Regional Medical Center Hospital, Rolla, MO, CCN 260017

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.128703ILMDFamily Medicine Physician
2012012827MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Phelps County Regional Medical Center CurrentSince Jun 24, 2023 Accepting new patients
Pcrmc Medical Group, Inc CurrentSince Jan 1, 2019 Accepting new patients
Phelps County Regional Medical Center CurrentSince Jan 1, 2019 Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients

Locations

1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

600 Blues Lake Pkwy
Rolla, MO 65401
Phone (573) 364-5719

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1415 W Scenic Rivers Blvd
Salem, MO 65560
Phone (573) 729-5533

Organizations & group practices 4

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.

Hospital & facility affiliations 6

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": "1330905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1821362088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 BLUES LAKE PKWY",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654018022",
            "telephone_number": "573-364-8822",
            "fax_number": "573-341-5969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 BLUES LAKE PKWY",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654018022",
            "telephone_number": "573-364-8822",
            "fax_number": "573-341-5969"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1415 W Scenic Rivers Blvd",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "MO",
            "postal_code": "655602840",
            "country_code": "US",
            "telephone_number": "573-729-5533",
            "fax_number": "573-202-2466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HURLEY",
        "first_name": "MATTHEW",
        "middle_name": "WARREN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-05",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.128703",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2012012827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rolla, MO

Sources for this page

Verify at the official NPI Registry.