Active NPI
Robert McDonnell, MSPT, MDT
- Physical Therapist
- Chicopee, MA
National Provider Identifier
1104868900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT014034L
- Practice address
- 591 Memorial Dr
Suite H
Chicopee, MA 01020-5024 - Phone
- (413) 331-1625
- Fax
- (413) 377-3178
- NPI assigned
- Jun 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | J10001531 | DE | |
| Physical Therapist | 225100000X | PT014034L | PA | Primary |
Addresses
Primary practice location
591 Memorial Dr
Suite H
Chicopee, MA 01020-5024
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1000037716 | Medicaid | DE | |
| 292670 | Other | MAMSI | |
| 5070-0091 | Other | NCA | |
| 1104868900 | Other | CHAMPUS | |
| 1039897 | Other | PABS | |
| 11416967 | Other | CAQH | |
| 1309897 | Other | PA | PABS |
| 2003135000 | Other | IBC | |
| 92839701 | Other | CAREFIRST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J10001531 | DE | MD | Physical Therapist |
| PT014034L | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493769600000",
"number": "1104868900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "591 MEMORIAL DR",
"address_2": "SUITE H",
"city": "CHICOPEE",
"state": "MA",
"postal_code": "010205024",
"telephone_number": "413-331-1625",
"fax_number": "413-377-3178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONNELL",
"first_name": "ROBERT",
"credential": "MSPT, MDT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-13",
"last_updated": "2017-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "DE",
"license": "J10001531",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT014034L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1000037716",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "292670",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCA",
"identifier": "5070-0091",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "1104868900",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PABS",
"identifier": "1039897",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11416967",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PABS",
"identifier": "1309897",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IBC",
"identifier": "2003135000",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST",
"identifier": "92839701",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicopee, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.