Matthew V Provenzano, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

1790 Hamill Rd
Hixson, TN 37343-4905

Phone

(423) 771-4600

Fax

(866) 591-0619

NPI assigned

Dec 19, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, GA2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Summit Physical Therapy, LLCGroup PAC ID 5799840211, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Summit Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Hixson, TN
  • NPI 1376796342

  GA

  Medicare reassignment Care Compare group
• Summit Physical Therapy

  • Physical Therapist
  • Hixson, TN
  • NPI 1225514110
  NPD (past)

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

{
    "created_epoch": "1324252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324252800000",
    "number": "1295004356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 HAMILL RD",
            "city": "HIXSON",
            "state": "TN",
            "postal_code": "373434905",
            "telephone_number": "423-771-4600",
            "fax_number": "866-591-0619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 HAMILL RD",
            "city": "HIXSON",
            "state": "TN",
            "postal_code": "373434905",
            "telephone_number": "423-771-4600",
            "fax_number": "866-591-0619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZANO",
        "first_name": "MATTHEW",
        "middle_name": "V",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-19",
        "last_updated": "2011-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Charles Poteralski
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• Premier Family Dental
• Alexa Grace Prince
• Ashley Elizabeth Prosser, DPT
• Zynia Pua, MD
• Publix Tennessee LLC
• Kurt Harold Pulver, PA
• Richard W Pyun, DMD
• Michael Quackenbush, O.D.

• Physical Therapist in Hixson, TN
• Providers in Hixson, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; 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.