Individual provider Active NPI

Matthew Smyk, PT

  • Physical Therapist
  • Portage, MI
National Provider Identifier
1396342796
Registry record updated Oct 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501019580 Issued in MI
Practice address
6016 Lovers LN Ste 3
Portage, MI 49002-3050
Phone
(269) 329-0934
NPI assigned
Oct 8, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501019580 MI Primary

Addresses

Primary practice location

6016 Lovers LN Ste 3
Portage, MI 49002-3050

Mailing address

607 Dewey Ave NW Ste 300
Grand Rapids, MI 49504-5283
Phone (616) 356-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201009002103 MI Practitioner - Physical Therapist in Private Practice 4082034269 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

6016 Lovers LN
Suite 3
Portage, MI 49002-3050

607 Dewey Ave NW
Suite 300
Grand Rapids, MI 49504-5283

625 Kenmoor Ave SE
Grand Rapids, MI 49546-2395

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5501019580MIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physical Therapy Group LLC Physical Therapist CurrentSince Oct 19, 2020 Accepting new patients

Locations

607 Dewey Ave NW
Ste 300
Grand Rapids, MI 49504
Phone (253) 332-3398

601 Michigan Ave
Ste 220
Holland, MI 49423
Phone (616) 355-4284

6016 Lovers Ln
Ste 3
Portage, MI 49002
Phone (269) 248-1946

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1602115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602115200000",
    "number": "1396342796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 DEWEY AVE NW STE 300",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495045283",
            "telephone_number": "616-356-5000",
            "fax_number": "616-356-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6016 LOVERS LN STE 3",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490023050",
            "telephone_number": "269-329-0934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMYK",
        "first_name": "MATTHEW",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-08",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501019580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2020; 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.