Individual provider Active NPI

Matthew Allen Magruder

  • Hearing Instrument Specialist
  • St Petersburg, FL
National Provider Identifier
1922691336
Registry record updated Feb 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hearing Instrument SpecialistTaxonomy code 237700000X
License
AS5384 Issued in FL
Practice address
1430 66TH St N
St Petersburg, FL 33710-5504
Phone
(727) 343-3019
NPI assigned
Feb 17, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hearing Instrument Specialist 237700000X AS5384 FL Primary

Addresses

Primary practice location

1430 66TH St N
St Petersburg, FL 33710-5504

Mailing address

11400 N Jog Rd
Palm Beach Gardens, FL 33418-1756
Phone (561) 453-3233

Other practice location 1

3146 Little Rd
Trinity, FL 34655-1864
Phone (727) 807-5694

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
AS5384FLMDHearing Instrument Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Audiology Distribution, LLC CurrentSince Feb 21, 2021 Accepting new patients
Lifestyle Hearing Corporation USA Inc Hearing Instrument Specialist PastSince Nov 19, 2020 Accepting new patients

Locations

11400 N Jog Rd
Palm Beach Gardens, FL 33418
Phone 5614788770 ext. 181

1430 66th St N
St Petersburg, FL 33710
Phone (727) 343-3019

250 Avenue K SW
Ste 105
Winter Haven, FL 33880
Phone (863) 268-2105

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1613520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613520000000",
    "number": "1922691336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11400 N JOG RD",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334181756",
            "telephone_number": "561-453-3233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 66TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337105504",
            "telephone_number": "727-343-3019"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3146 Little Rd",
            "address_purpose": "LOCATION",
            "city": "Trinity",
            "state": "FL",
            "postal_code": "346551864",
            "country_code": "US",
            "telephone_number": "727-807-5694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAGRUDER",
        "first_name": "MATTHEW",
        "middle_name": "ALLEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-17",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "FL",
            "license": "AS5384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; 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.