Samuel Clayton Mackay, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305215590 Issued in VA

Practice address

5928 Seminole TRL Ste 103
Barboursville, VA 22923-2872

Phone

(434) 985-2198

NPI assigned

Mar 15, 2023

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Advanced Center for Physical Therapy, PLC

  • Physical Therapy Clinic/Center
  • Barboursville, VA
  • NPI 1013169473
  NPD (past)

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

{
    "created_epoch": "1678838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728259200000",
    "number": "1619678711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 392573",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152519573",
            "telephone_number": "724-343-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5928 SEMINOLE TRL STE 103",
            "city": "BARBOURSVILLE",
            "state": "VA",
            "postal_code": "229232872",
            "telephone_number": "434-985-2198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKAY",
        "first_name": "SAMUEL",
        "middle_name": "CLAYTON",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-15",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305215590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Carley Marie Fisher
• Kaylyn Hopkins
• Jon a. Whalen, PC
• Katharine Kuekes-Baker, RN
• Level Up Physical Therapy
• Thomspon Femi Malumi
• Aileen Marie McKernan
• Kira Memery, DPT
• David M. Mercer, ACNP
• Mercernpservices LLC

• Physical Therapist in Barboursville, VA
• Providers in Barboursville, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.