Individual provider Active NPI

Rick Nelson Prothero, PT

  • Orthopedic Physical Therapist
  • Havre de Grace, MD
National Provider Identifier
1306846985
Registry record updated Sep 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
14518 Issued in MD
Practice address
807A S Union Ave
Havre de Grace, MD 21078-3610
Phone
(410) 939-2262
Fax
(410) 939-7119
NPI assigned
Jul 26, 2005
Last updated
Sep 23, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 14518 MD Primary

Addresses

Primary practice location

807A S Union Ave
Havre de Grace, MD 21078-3610

Mailing address

807A S Union Ave
Havre de Grace, MD 21078-3610
Phone (410) 939-2262

Other identifiers 2

IdentifierTypeStateIssuer
650020355OtherMDRAILROAD MEDICARE
391101200MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101020000517 MD Practitioner - Physical Therapist in Private Practice 7214943760 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Smith and Prothero Physical Therapy LLCGroup PAC ID 9335155860, 9 clinicians

Practice addresses (Care Compare)

807 A S Union Ave
Havre de Grace, MD 21078-3610
Phone (410) 939-2262

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
14518MDMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Smith & Prothero Physical Therapy LLC Orthopedic CurrentSince Jul 18, 2000 Accepting new patients
Smith & Prothero Physical Therapy LLC CurrentSince Nov 10, 2019 Accepting new patients

Locations

807 S Union Ave
#A
Havre de Grace, MD 21078
Phone (410) 939-2262

807A S Union Ave
Hvre de Grace, MD 21078
Phone (410) 939-2262

Organizations & group practices 2

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": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316736000000",
    "number": "1306846985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807A S UNION AVE",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783610",
            "telephone_number": "410-939-2262",
            "fax_number": "410-939-7119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807A S UNION AVE",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783610",
            "telephone_number": "410-939-2262",
            "fax_number": "410-939-7119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROTHERO",
        "first_name": "RICK",
        "middle_name": "NELSON",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-26",
        "last_updated": "2011-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MD",
            "license": "14518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "650020355",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "391101200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Havre de Grace, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.