Individual provider Active NPI

Matthew P Brennan, PT, DPT

  • Physical Therapist
  • Glen Allen, VA
National Provider Identifier
1497981161
Registry record updated Jan 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305206387 Issued in VA
Practice address
10128 W Broad St
Forum Building III, Suite K
Glen Allen, VA 23060-6761
Phone
(804) 217-9210
Fax
(804) 217-9213
NPI assigned
Jun 8, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2011

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 11681 NC
Physical Therapist 225100000X 2305206387 VA Primary

Addresses

Primary practice location

10128 W Broad St
Forum Building III, Suite K
Glen Allen, VA 23060-6761

Mailing address

771 Pilot House Dr
Newport News, VA 23606-1990
Phone (757) 873-2302

Other identifiers 4

IdentifierTypeStateIssuer
9223520OtherVAAETNA
P00826481OtherVARAILROAD MEDICARE
192953OtherVABCBS (PHYSICAL THERAPY)
1497981161MedicaidVA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260527001935 DC Practitioner - Physical Therapist in Private Practice 8325191158 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2708 Rutgers CT
Henrico, VA 23233-1699

PO Box
Suite 290609
Nashville, TN 37229

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11681NCMDProfessional Counselor

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": "1244419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295136000000",
    "number": "1497981161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "771 PILOT HOUSE DR",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236061990",
            "telephone_number": "757-873-2302",
            "fax_number": "757-873-2306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10128 W BROAD ST",
            "address_2": "FORUM BUILDING III, SUITE K",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230606761",
            "telephone_number": "804-217-9210",
            "fax_number": "804-217-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNAN",
        "first_name": "MATTHEW",
        "middle_name": "P",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-08",
        "last_updated": "2011-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "11681",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305206387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9223520",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00826481",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS (PHYSICAL THERAPY)",
            "identifier": "192953",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497981161",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Allen, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2011; 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.