Active NPI
Samuel Pearson, PT, DPT
- Physical Therapist
- Richmond, VA
National Provider Identifier
1154742724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2305208472
- Practice address
- 5801 Patterson Ave
Richmond, VA 23226-2536 - Phone
- (804) 288-1380
- Fax
- (804) 288-1383
- NPI assigned
- Dec 26, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2305208472 | VA | Primary |
Addresses
Primary practice location
5801 Patterson Ave
Richmond, VA 23226-2536
Mailing address
PO Box 69030
Baltimore, MD 21264-9030
Phone (757) 873-2302
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C05954 | Other | VA | MEDICARE GROUP PTAN |
| 1154742724 | Other | VA | MEDICAID QMB ONLY |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler | Other | Fox Rehabilitation Services LLC |
| CONNECT URL | https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler | Other | Fox Rehabilitation Services LLC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA, DC
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140306002079 | VA | Practitioner - Physical Therapist in Private Practice | 1355571662 | Reassigns benefits to 2 organizations |
| I20190320002267 | DC | Practitioner - Physical Therapist in Private Practice | 1355571662 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3925 Downs Dr
Chantilly, VA 20151-3308
Phone (703) 810-3992
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tidewater Physical Therapy, LLC | Physical Therapist | Current | Accepting new patients |
| Tidewater Physical Therapy, LLC | Physical Therapist | Current | Accepting new patients |
| Tidewater Physical Therapy LLC | Physical Therapist | Past | Accepting new patients |
| Tidewater Physical Therapy, LLC | Physical Therapist | Past | Accepting new patients |
| Tidewater Physical Therapy, LLC | Physical Therapist | Past | Accepting new patients |
| Tidewater Physical Therapy LLC | Physical Therapist | Past | Accepting new patients |
| Tidewater Physical Therapy LLC | Physical Therapist | Past | Accepting new patients |
| Tidewater Physical Therapy LLC | Physical Therapist | Past | Accepting new patients |
Locations
10128 W Broad St
Bldg Iii
Glen Allen, VA 23060
Phone (804) 217-9210
5801 Patterson Ave
Richmond, VA 23226
Phone (804) 288-1380
Organizations & group practices 9
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1388016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748304000000",
"number": "1154742724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 69030",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212649030",
"telephone_number": "757-873-2302",
"fax_number": "757-873-2306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5801 PATTERSON AVE",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232262536",
"telephone_number": "804-288-1380",
"fax_number": "804-288-1383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEARSON",
"first_name": "SAMUEL",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-12-26",
"last_updated": "2025-05-27",
"certification_date": "2025-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VA",
"license": "2305208472",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP PTAN",
"identifier": "C05954",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID QMB ONLY",
"identifier": "1154742724",
"state": "VA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
"affiliationName": "Fox Rehabilitation Services LLC",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "20 E Piccadilly St Ste 11&14",
"city": "Winchester",
"state": "VA",
"country_code": "US",
"postal_code": "226013971",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
"affiliationName": "Fox Rehabilitation Services LLC",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "3925 Downs Dr",
"city": "Chantilly",
"state": "VA",
"country_code": "US",
"postal_code": "201513308",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Richmond, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2025; 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.