Individual provider Active NPI

Shaun M Riney, PHYSICAL THERAPY

  • Physical Therapist
  • Matthews, NC
National Provider Identifier
1063429314
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
P10029 Issued in NC
Practice address
1205 Mann Dr
Matthews, NC 28105-7592
Phone
(704) 323-3278
NPI assigned
Aug 1, 2006
Last updated
Dec 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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 P10029 NC Primary

Addresses

Primary practice location

1205 Mann Dr
Matthews, NC 28105-7592

Mailing address

PO Box 601791
Charlotte, NC 28260-1791

Other practice location 1

15825 Ballantyne Medical Pl
Suite 120
Charlotte, NC 28277-4652
Phone (704) 323-2000

Other identifiers 3

IdentifierTypeStateIssuer
7211864MedicaidNC
079XROtherNCBCBSNC
185970OtherNYMEDCOST

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110422000313 NC Practitioner - Physical Therapist in Private Practice 0143405852 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P10029NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthocarolina Physical Therapist Current Accepting new patients
Orthocarolina Physical Therapist CurrentSince May 2, 2011 Accepting new patients
Orthocarolina Physical Therapist CurrentSince May 2, 2011 Accepting new patients

Locations

15825 Ballantyne Medical Pl
Ste 100
Charlotte, NC 28277
Phone (704) 323-3400

1915 Randolph Rd
Charlotte, NC 28207
Phone (704) 339-1000

4601 Park Rd
Ste 300
Charlotte, NC 28209
Phone (704) 323-2090

703 Comfort Ln
Monroe, NC 28112
Phone (704) 226-9550

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1063429314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601791",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 MANN DR",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281057592",
            "telephone_number": "704-323-3278"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15825 Ballantyne Medical Pl",
            "address_2": "Suite 120",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282774652",
            "country_code": "US",
            "telephone_number": "704-323-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RINEY",
        "first_name": "SHAUN",
        "middle_name": "M",
        "credential": "PHYSICAL THERAPY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P10029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7211864",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "079XR",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "185970",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Matthews, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.