Matthew M Kenick, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA3593 Issued in FL

Practice address

1625 SE 3Rd Ave Ste 300
Fort Lauderdale, FL 33316-2521

Phone

(954) 355-4665

Fax

(954) 355-4881

NPI assigned

May 17, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

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.

• Eugene N. Costantini, M.D.,P.a.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Ft Lauderdale, FL
  • NPI 1295033041
  Medicare reassignment
• North Broward Hospital District

  • Neurological Surgery Physician
  • Fort Lauderdale, FL
  • NPI 1801581129
  Medicare reassignment
• North Broward Hospital District

  • Community/Retail Pharmacy
  • Pompano Beach, FL
  • NPI 1699709766
  NPD
• North Broward Hospital District

  • Family Medicine Physician
  • Plantation, FL
  • NPI 1790333029
  NPD

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753747200000",
    "number": "1922051614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1608 SE 3RD AVE FL 3",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162564",
            "telephone_number": "954-355-4665",
            "fax_number": "954-355-4881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 SE 3RD AVE STE 300",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162521",
            "telephone_number": "954-355-4665",
            "fax_number": "954-355-4881"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1625 SE 3rd Ave Ste 355",
            "address_purpose": "LOCATION",
            "city": "Fort Lauderdale",
            "state": "FL",
            "postal_code": "333162521",
            "country_code": "US",
            "telephone_number": "954-355-5001",
            "fax_number": "954-355-4881",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENICK",
        "first_name": "MATTHEW",
        "middle_name": "M",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA3593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290516700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donald W Kelly, LMHC
• Kathleen Kelly, MSW, LCSW
• Kerry Kathleen Kelly, ARNP
• Katrina Schiefer Kemos, LCSW
• Sonja Kempski, LMT
• David Noah Kenigsberg, MD
• Ingrid Kenna, PTA
• Ainsley Kennard, PSYD
• Cierro Kennedy
• Yehudis Kenner

• Physician Assistant in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2025; 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.

Verify at the official NPI Registry.