Individual provider Active NPI

Matthew Samuel Gregory, PT

  • Physical Therapist
  • La Fayette, GA
National Provider Identifier
1356637623
Registry record updated Jan 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT010294 Issued in GA
Practice address
106 Pearl Dr
Suite 104
La Fayette, GA 30728-7509
Phone
(706) 638-3880
Fax
(706) 638-3890
NPI assigned
Jun 24, 2011
Last updated
Jan 2, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT010294 GA Primary
Athletic Trainer 2255A2300X AT001633 GA

Addresses

Primary practice location

106 Pearl Dr
Suite 104
La Fayette, GA 30728-7509

Mailing address

PO Box 528
Rome, GA 30162-0528
Phone (706) 638-3880

Other practice location 1

13423 Highway 27 Ste A
Trion, GA 30753-1556
Phone (706) 696-0505

Other practice location 2

1711 Martha Berry Blvd NW
Rome, GA 30165-1623
Phone (706) 528-4207

Other practice location 3

12415 N Main Street
Trenton, GA 30752-3075
Phone (706) 657-2700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110712000129 GA Practitioner - Physical Therapist in Private Practice 1951579242 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Performance Physical Therapy and Sports Medicine IncGroup PAC ID 8426112137, 13 clinicians

Practice addresses (Care Compare)

13423 Hwy 27
Suite a
Trion, GA 30753-1556
Phone (706) 696-0505

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AT001633GAMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Performance Physical Therapy & Sports Medicine Inc Physical Therapist CurrentSince Jun 23, 2011 Accepting new patients

Locations

106 Pearl Dr
Ste 104
La Fayette, GA 30728
Phone (706) 638-3880

1711 Martha Berry Blvd NW
Rome, GA 30165
Phone (706) 528-4207

13423 Highway 27
Ste A
Trion, GA 30753
Phone (706) 696-0505

Organizations & group practices 1

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": "1308873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704153600000",
    "number": "1356637623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 528",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301620528",
            "telephone_number": "706-638-3880",
            "fax_number": "706-638-3890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 PEARL DR",
            "address_2": "SUITE 104",
            "city": "LA FAYETTE",
            "state": "GA",
            "postal_code": "307287509",
            "telephone_number": "706-638-3880",
            "fax_number": "706-638-3890"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13423 Highway 27 Ste A",
            "address_purpose": "LOCATION",
            "city": "Trion",
            "state": "GA",
            "postal_code": "307531556",
            "country_code": "US",
            "telephone_number": "706-696-0505",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1711 Martha Berry Blvd NW",
            "address_purpose": "LOCATION",
            "city": "Rome",
            "state": "GA",
            "postal_code": "301651623",
            "country_code": "US",
            "telephone_number": "706-528-4207",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12415 N Main Street",
            "address_purpose": "LOCATION",
            "city": "Trenton",
            "state": "GA",
            "postal_code": "307523075",
            "country_code": "US",
            "telephone_number": "706-657-2700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREGORY",
        "first_name": "MATTHEW",
        "middle_name": "SAMUEL",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-24",
        "last_updated": "2024-01-02",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT010294",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT001633",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Fayette, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; 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.