Matthew Sullivan

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5279 Issued in NM

Practice address

1935 Warner Ave
Santa Fe, NM 87505-5452

Phone

(505) 906-6683

Fax

(505) 421-0271

NPI assigned

Jul 12, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pure Movement, LLCGroup PAC ID 4284026113, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pure Movement, LLC

  • Physical Therapy Clinic/Center
  • Santa Fe, NM
  • NPI 1972194884

  Physical Therapist

  Medicare reassignment Care Compare group NPD Authorized official
• Kansas City Performance Physical Therapy

  dba Onward Kansas City

  • Physical Therapy Clinic/Center
  • Prairie Village, KS
  • NPI 1356182968
  NPD Authorized official

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

{
    "created_epoch": "1468281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649289600000",
    "number": "1619329703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1935 WARNER AVE",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875055452",
            "telephone_number": "505-906-6683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 WARNER AVE",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875055452",
            "telephone_number": "505-906-6683",
            "fax_number": "505-421-0271"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "223 N Guadalupe St # 593",
            "address_purpose": "LOCATION",
            "city": "Santa Fe",
            "state": "NM",
            "postal_code": "875011868",
            "country_code": "US",
            "telephone_number": "316-648-8105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MATTHEW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-12",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL.0014097",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "5279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Success Smiles Orthodontics Santa Fe
• Sudha Rani Kailas LLC (Holistic Psychiatry)
• E Dow Suhre, MD
• Shawn Elliot Sulak, D.N.
• Laura Marie Sullivan, LISW
• Noreen M Sullivan, D.C.
• P. Alexander Sullivan, L.M.T. 2569
• Sally Sullivan, LMHC
• Spirit Sullivan, RDH
• Betsy G Sultan, ROLF PRACTITIONER

• Physical Therapist in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Physical Therapist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2022; 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.