Active NPI
Mathew Samkutty, OCCUPATIONAL THERAPI
- Occupational Therapist
- Milwaukie, OR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1023500
- Practice address
- 4560 SE International Way
Consonus Rehab Services
Milwaukie, OR 97222 - Phone
- (971) 206-5140
- Fax
- (971) 206-5209
- NPI assigned
- Sep 28, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 1023500 | OR | Primary |
Addresses
Primary practice location
4560 SE International Way
Consonus Rehab Services
Milwaukie, OR 97222
Mailing address
4560 SE International Way
Milwaukie, OR 97222
Phone (971) 206-5140
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 274812 | Other | OR | OMAP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 1997
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1335 Stranssner Dr
Brentwood, MO 63144-1872
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1023500 | OR | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Empowerme Rehabilitation Illinois, LLC | Occupational Therapist | Current | Accepting new patients |
| Empowerme Wellness Kansas City, LLC | Current | Accepting new patients | |
| Empowerme Wellness Kansas City, LLC | Occupational Therapist | Current | Accepting new patients |
| Empowerme Rehabilitation Illinois, LLC | Occupational Therapist | Current | Accepting new patients |
Locations
1021 W E St
Belleville, IL 62220
Phone (618) 233-2095
7108 Marine Rd
Edwardsville, IL 62025
Phone (618) 706-9759
1335 Strassner Dr
Saint Louis, MO 63144
Phone (314) 673-6723
Organizations & group practices 4
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.
-
- Occupational Therapist
- Edwardsville, IL
- NPI 1679098263
-
- Multi-Specialty Clinic/Center
- Belleville, IL
- NPI 1174118103
Occupational Therapist
-
- Rehabilitation Clinic/Center
- Mount Carmel, IL
- NPI 1962073734
Occupational Therapist
-
- Rehabilitation Clinic/Center
- Liberty, MO
- NPI 1174299044
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1306937826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4560 SE INTERNATIONAL WAY",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "97222",
"telephone_number": "971-206-5140",
"fax_number": "971-206-5209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4560 SE INTERNATIONAL WAY",
"address_2": "CONSONUS REHAB SERVICES",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "97222",
"telephone_number": "971-206-5140",
"fax_number": "971-206-5209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMKUTTY",
"first_name": "MATHEW",
"credential": "OCCUPATIONAL THERAPI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OR",
"license": "1023500",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OMAP",
"identifier": "274812",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Milwaukie, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.