Wayne Allen Mathews, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-000394 Issued in IL

Practice address

250 W Kenwood Ave
Decatur, IL 62526-4371

Phone

(217) 872-3800

Fax

(217) 872-0849

NPI assigned

Oct 28, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Illiana Emergency Physicians LLP

  • Emergency Medicine Physician
  • Greenville, IL
  • NPI 1730426941
  NPD (past)
• Kirby Medical Center

  • Community/Retail Pharmacy
  • Monticello, IL
  • NPI 1568074714
  NPD (past)
• Kirby Medical Center

  • Rural Health Clinic/Center
  • Atwood, IL
  • NPI 1740271667
  NPD (past)

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386806400000",
    "number": "1891786943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 W KENWOOD AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264371",
            "telephone_number": "217-872-3800",
            "fax_number": "217-872-0849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 W KENWOOD AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264371",
            "telephone_number": "217-872-3800",
            "fax_number": "217-872-0849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEWS",
        "first_name": "WAYNE",
        "middle_name": "ALLEN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2013-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-000394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan K Martin
• Amanda Martz
• Angie Mason, RBT
• Anita F Mason, MA; LMFT
• Fidel Mata, P.A.
• Maggie Kaye Matthews, NP
• Victoria Princess Matthews, FNP
• David Mark Mattiuz, PHARM.D.
• Maxover, LLC
• Kayla Maxwell, OTR/L

• Physician Assistant in Decatur, IL
• Providers in Decatur, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.