Active NPI
Matthew Haley Bishop, PTA
- Physical Therapy Assistant
- Germantown, WI
National Provider Identifier
1205426822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 3055-19
- Practice address
- W173N10915 Bernies Way
Germantown, WI 53022-4043 - Phone
- (262) 509-3300
- NPI assigned
- Jan 19, 2021
- Last updated
- Jan 19, 2021
- 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 Therapy Assistant | 225200000X | 3055-19 | WI | Primary |
Addresses
Primary practice location
W173N10915 Bernies Way
Germantown, WI 53022-4043
Mailing address
W173N10915 Bernies Way
Germantown, WI 53022-4043
Phone (262) 509-3300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154442515 | Medicaid | WI |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Germantown | Health Information Exchange (HIE) | |
| CONNECT URL | Germantown |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3055-19 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611014400000",
"number": "1205426822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W173N10915 BERNIES WAY",
"city": "GERMANTOWN",
"state": "WI",
"postal_code": "530224043",
"telephone_number": "262-509-3300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W173N10915 BERNIES WAY",
"city": "GERMANTOWN",
"state": "WI",
"postal_code": "530224043",
"telephone_number": "262-509-3300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BISHOP",
"first_name": "MATTHEW",
"middle_name": "HALEY",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-19",
"last_updated": "2021-01-19",
"certification_date": "2021-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "3055-19",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1154442515",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Germantown",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "W173N10915 Bernies Way",
"city": "Germantown",
"state": "WI",
"country_code": "US",
"postal_code": "530224043",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Germantown",
"affiliation": "N",
"endpointDescription": "Long term care",
"address_1": "W173N10915 Bernies Way",
"city": "Germantown",
"state": "WI",
"country_code": "US",
"postal_code": "530224043",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Germantown, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.