Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Matthew James Revennaugh, PA

Individual provider Physician Assistant · NPI 1619562386

Matthew James Revennaugh, PA is a Physician Assistant in Richmond, Indiana. Qualified in 2020, 6 years ago. Practices with Reid Physician Associates Inc, a 423-clinician group and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
6
Licensed in
IN
In the registry since
2021
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1400 Highland Rd Ste 1
Richmond, IN 47374-8810
Phone: (765) 935-8905
Fax: (765) 939-4200
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 10003154A (IN)

Record details

NPI number1619562386
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedMarch 4, 2021
Last updated in NPPESSeptember 22, 2021
Certification dateSeptember 22, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Reid Physician Associates Inc — 423 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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