Matthew Charles Revilla, PA-C is a medicare enrolled "Physician Assistant" physician in Palmetto, Georgia. His current practice location is
507 Park St, Palmetto, Georgia. You can reach out to his office (for appointments etc.) via phone at
(770) 463-4644.
Matthew Charles Revilla is licensed to practice in Georgia (license number 9684) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1821617036.
Physician's Profile
Full Name | Matthew Charles Revilla |
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Gender | Male |
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Speciality | Physician Assistant |
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Location | 507 Park St, Palmetto, Georgia |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1821617036
- Provider Enumeration Date: 04/09/2020
- Last Update Date: 08/27/2021
Medicare PECOS Information:
- PECOS PAC ID: 6204230543
- Enrollment ID: I20210809000855
Medical Identifiers
Medical identifiers for Matthew Charles Revilla such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1821617036 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207QA0505X | Family Medicine - Adult Medicine | 9684 (Georgia) | Secondary |
363A00000X | Physician Assistant | 9684 (Georgia) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Matthew Charles Revilla is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Matthew Charles Revilla, PA-C 643 Main St, Palmetto, GA 30268-1138 Ph: (404) 929-8824 | Matthew Charles Revilla, PA-C 507 Park St, Palmetto, GA 30268-1007 Ph: (770) 463-4644 |
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