Matthew S Bourdeau, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

24069 Issued in MD

Practice address

2900 S Hanover St
Baltimore, MD 21225-1232

Phone

(301) 540-6140

Fax

(301) 540-5190

NPI assigned

Jul 18, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Maryland School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
• Direct secure messaging: matthew.bourdeau.1@8042.direct.athenahealth.com

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.

• Privia Medical Group, LLC

  • Internal Medicine Physician
  • Arlington, VA
  • NPI 1013042480

  MD

  Medicare reassignment Care Compare group NPD
• Felice Physical Therapy

  • Physical Therapy Clinic/Center
  • Hunt Valley, MD
  • NPI 1851774475

  Physical Therapist

  Medicare reassignment NPD
• Privia Medical Group, LLC

  • Pain Medicine (Psychiatry & Neurology) Physician
  • Rockville, MD
  • NPI 1811715436
  NPD
• Nova Physician Wellness Center PLLC

  • Family Medicine Physician
  • Fairfax, VA
  • NPI 1215307400
  NPD (past)

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

{
    "created_epoch": "1342569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471651200000",
    "number": "1487909263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2653 CEDAR ELM DR",
            "address_2": "NRH REHAB NETWORK - #215",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211132905",
            "telephone_number": "410-708-4763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 S HANOVER ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212251232",
            "telephone_number": "301-540-6140",
            "fax_number": "301-540-5190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURDEAU",
        "first_name": "MATTHEW",
        "middle_name": "S",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-18",
        "last_updated": "2016-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "24069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Travis S Bouldin
• Kelsey Ayne Boulier, MS, LAT, ATC
• Leigh Ebony Boulware, M.D.
• Natalie J Boulware, NATUROPATH
• Boundless Innovations for Holistc Living
• Denis Lee Bourke, M.D.
• Mohammad Bourmaf
• Paige R Bourne, DPT
• Douglas Michael Bourque, MD
• Tatiana Bourque

• Physical Therapist in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2016; 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.