Individual provider Active NPI

Matthew David Rose, PA STUDENT

  • Physician Assistant
  • Abilene, TX
National Provider Identifier
1861929796
Registry record updated Aug 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
850 N 6TH St
Abilene, TX 79601-5242
Phone
(325) 692-5600
NPI assigned
May 23, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 12, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X
Ambulatory Family Planning Facility 261QA0005X
State or Local Public Health Clinic/Center 261QP0905X
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X Primary

Addresses

Primary practice location

850 N 6TH St
Abilene, TX 79601-5242

Mailing address

801 N Donald St
Seymour, TX 76380-1637
Phone (940) 631-1339

Other practice location 1

801 N Donald St
Seymour, TX 76380-1637
Phone (940) 631-1339

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20171130002334 TX Practitioner - Physician Assistant 5092072967 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Quantum Emergency Physicians PAGroup PAC ID 1153414503, 79 clinicians

Practice addresses (Care Compare)

1900 Pine St
Abilene, TX 79601-2432
Phone (325) 670-2000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
City of Abilene Public Health Or Welfare CurrentSince Aug 4, 2024 Accepting new patients
Hendrick Medical Center Single Specialty PastSince Aug 4, 2024 Accepting new patients

Locations

850 N 6th St
Abilene, TX 79601
Phone (325) 692-5600

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 3

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": "1495497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1861929796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 N DONALD ST",
            "city": "SEYMOUR",
            "state": "TX",
            "postal_code": "763801637",
            "telephone_number": "940-631-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 N 6TH ST",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796015242",
            "telephone_number": "325-692-5600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 N Donald St",
            "address_purpose": "LOCATION",
            "city": "Seymour",
            "state": "TX",
            "postal_code": "763801637",
            "country_code": "US",
            "telephone_number": "940-631-1339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSE",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "credential": "PA STUDENT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-23",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0005X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Family Planning Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Abilene, TX

Sources for this page

Verify at the official NPI Registry.