Individual provider Active NPI

Sidmael Butler-Rivera

  • Physical Therapist
  • Jersey City, NJ
National Provider Identifier
1063367274
Registry record updated Mar 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA02405000 Issued in NJ
Practice address
2 Journal Square PLZ FL D1
Jersey City, NJ 07306-4001
Phone
(201) 366-1120
NPI assigned
Mar 3, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 40QA02405000 NJ Primary

Addresses

Primary practice location

2 Journal Square PLZ FL D1
Jersey City, NJ 07306-4001

Mailing address

609 Palisade Ave Apt 1
Jersey City, NJ 07307-1023
Phone (787) 566-0552

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260410002035 NJ Practitioner - Physical Medicine and Rehabilitation 0042785685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Liberty Physical Therapy PCGroup PAC ID 2961678537, 11 clinicians

Practice addresses (Care Compare)

115 Christopher Columbus Dr
Suite 300
Jersey City, NJ 07302-3551
Phone (551) 200-6975

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA02405000NJMDPhysical Therapist

Organizations & group practices 1

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": "1772496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772928000000",
    "number": "1063367274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 PALISADE AVE APT 1",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073071023",
            "telephone_number": "787-566-0552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 JOURNAL SQUARE PLZ FL D1",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073064001",
            "telephone_number": "201-366-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER-RIVERA",
        "first_name": "SIDMAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-03-03",
        "last_updated": "2026-03-08",
        "certification_date": "2026-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA02405000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

Sources for this page

Verify at the official NPI Registry.