Active NPI
Matthew Vernon Hansen, PA-C
- Medical Physician Assistant
- Randolph, TX
National Provider Identifier
1871686444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 1025979
- Practice address
- 221 3Rd St West
12 Medical Group
Randolph, TX 78150-4801 - Phone
- (210) 652-9836
- NPI assigned
- Oct 2, 2006
- Last updated
- Jul 8, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 1025979 | Primary |
Addresses
Primary practice location
221 3Rd St West
12 Medical Group
Randolph, TX 78150-4801
Mailing address
3331 Trailway Park
San Antonio, TX 78247
Phone (210) 722-2274
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130123000393 | TX | Order and Referring Only - Physician Assistant | 7719130855 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871686444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3331 TRAILWAY PARK",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78247",
"telephone_number": "210-722-2274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 3RD ST WEST",
"address_2": "12 MEDICAL GROUP",
"city": "RANDOLPH",
"state": "TX",
"postal_code": "781504801",
"telephone_number": "210-652-9836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSEN",
"first_name": "MATTHEW",
"middle_name": "VERNON",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": "1025979",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Randolph, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.