Individual provider Active NPI

Matthew Wittwer

  • Occupational Therapist
  • Boulder City, NV
National Provider Identifier
1457710709
Registry record updated Jun 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT-2564 Issued in NV
Practice address
1000 Nevada Way Ste 205
Boulder City, NV 89005-1829
Phone
(702) 246-2782
Fax
(702) 750-1372
NPI assigned
Feb 15, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X
Occupational Therapist 225X00000X OT-2564 NV Primary

Addresses

Primary practice location

1000 Nevada Way Ste 205
Boulder City, NV 89005-1829

Mailing address

1333 N Buffalo Dr Unit 170
Las Vegas, NV 89128-3637
Phone (702) 564-6712

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201116002942 NV Practitioner - Occupational Therapist in Private Practice 4284045634 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Affiliated Physical TherapyGroup PAC ID 1951453075, 47 clinicians

Practice addresses (Care Compare)

1525 E Windmill LN
Suite 102
Las Vegas, NV 89123-1903
Phone (702) 660-2694

6050 S Fort Apache Rd
Suite 120
Las Vegas, NV 89148-5614
Phone (702) 728-5735

806 Buchanan Blvd
Suite 103
Boulder City, NV 89005-2130
Phone (702) 246-2787

9050 W Cheyenne Ave
Suite 210
Las Vegas, NV 89129-8932
Phone (702) 660-2694

Merit-based Incentive Payment System (MIPS)

Final score
58.17 of 100Reported as group
Quality
37.51
Improvement activities
40
Cost
75.14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT-2564NVMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Affiliated Physical Therapy Occupational Therapist CurrentSince Nov 12, 2020 Accepting new patients
Meaningful Gains Therapy LLC PastSince Jun 22, 2021 Accepting new patients
Therapy West LLC Past Accepting new patients

Locations

806 Buchanan Blvd
Ste 103
Boulder City, NV 89005
Phone (702) 246-2787

1000 Nevada Way
Ste 205
Boulder City, NV 89005
Phone (702) 246-2782

9050 W Cheyenne Ave
#210
Las Vegas, NV 89129
Phone (702) 209-0069

1525 E Windmill Ln
Ste 102
Las Vegas, NV 89123
Phone (702) 508-9325

1333 N Buffalo Dr
Unit 170
Las Vegas, NV 89128
Phone (702) 660-2694

3840 W Ann Rd
Ste 101B
North Las Vegas, NV 89031
Phone (702) 660-2694

2250 Postal Dr
Ste 4
Pahrump, NV 89048
Phone (775) 727-3838

Organizations & group practices 3

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": "1455494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1457710709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 N BUFFALO DR UNIT 170",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891283637",
            "telephone_number": "702-564-6712",
            "fax_number": "702-564-4838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 NEVADA WAY STE 205",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "890051829",
            "telephone_number": "702-246-2782",
            "fax_number": "702-750-1372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITTWER",
        "first_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-15",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NV",
            "license": "OT-2564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder City, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; 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.