MATTHEW S BERTUS P.A. NPI 1093706368

NPI Information

NPI: 1093706368
Provider Name: MATTHEW S BERTUS, P.A.
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
4050 W MEMORIAL RD
THIRD FLOOR
OKLAHOMA CITY, OK
ZIP 73120
Phone: (405) 608-3800
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Matthew S Bertus, P.A. is a medical physician assistant in Oklahoma City, OK. Matthew S Bertus, P.A. NPI is 1093706368. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4050 W MEMORIAL RD
THIRD FLOOR
OKLAHOMA CITY, OK
ZIP 73120-382
Phone: (405) 608-3800
Fax: (405) 608-3838

The NPI 1093706368 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/4/2005 and was last updated on 2/17/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363A00000X	Physician Assistant		861	OKLAHOMA	No
2	363AM0700X	Physician Assistant	Medical	861	OKLAHOMA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	OKA102012	MEDICARE PIN	OKLAHOMA
2	24H616502	MEDICARE PIN	OKLAHOMA
3	S66586	MEDICARE UPIN	OKLAHOMA
4	OKA100690	MEDICARE PIN	OKLAHOMA
5	349532203	MEDICARE ID-TYPE UNSPECIFIED	OKLAHOMA
6	10011900A	MEDICAID	OKLAHOMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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