Individual provider Active NPI

Marc Dale Muzzarelli, PT

  • Orthopedic Physical Therapist
  • Port Huron, MI
National Provider Identifier
1629215405
Registry record updated Nov 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
5501003783 Issued in MI
Practice address
940 River Centre Dr
Port Huron, MI 48060-4463
Phone
(810) 985-7412
NPI assigned
Jan 15, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 5501003783 MI Primary

Addresses

Primary practice location

940 River Centre Dr
Port Huron, MI 48060-4463

Mailing address

940 River Centre Dr
Port Huron, MI 48060-4463
Phone (810) 985-7412

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101221000600 MI Practitioner - Physical Therapist in Private Practice 0042408866 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Wayne State University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic Associates of Port Huron PCGroup PAC ID 1951391093, 22 clinicians

Practice addresses (Care Compare)

940 River Centre Dr
Port Huron, MI 48060-4463
Phone (810) 985-4900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5501003783MIMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Associates of Port Huron PC CurrentSince Nov 1, 2010 Accepting new patients
Orthopedic Associates of Port Huron PC Past Accepting new patients

Locations

940 River Centre Dr
Port Huron, MI 48060
Phone (810) 985-4900

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AIIFDD

Organizations & group practices 2

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": "1231977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288742400000",
    "number": "1629215405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 RIVER CENTRE DR",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480604463",
            "telephone_number": "810-985-7412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 RIVER CENTRE DR",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480604463",
            "telephone_number": "810-985-7412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUZZARELLI",
        "first_name": "MARC",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-15",
        "last_updated": "2010-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MI",
            "license": "5501003783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2010; 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.