Individual provider Active NPI

Matthew Staback, DPT

  • Physical Therapist
  • Middletown, NY
National Provider Identifier
1649791518
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
048606 Issued in NY
Practice address
1219 Dolsontown Rd
Middletown, NY 10940-4749
Phone
(845) 344-1899
NPI assigned
Jun 30, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X
Physical Therapist 225100000X 048606 NY Primary

Addresses

Primary practice location

1219 Dolsontown Rd
Middletown, NY 10940-4749

Mailing address

111 Maltese Dr
Middletown, NY 10940-2141
Phone (845) 342-4774

Other identifiers 1

IdentifierTypeStateIssuer
048606OtherNYNYS LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220603000774 NY Practitioner - Physical Therapist in Private Practice 5092193003 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Middletown Medical PCGroup PAC ID 2567464308, 177 clinicians

Practice addresses (Care Compare)

111 Maltese Dr
Middletown, NY 10940-2115
Phone (845) 342-4774

Merit-based Incentive Payment System (MIPS)

Final score
84.92 of 100Reported as group
Quality
68.46
Promoting interoperability
99
Improvement activities
40
Cost
77.61

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Middletown Medical PC CurrentSince Apr 7, 2022 Accepting new patients
Middletown Medical PC CurrentSince Apr 7, 2022 Accepting new patients

Locations

419 E Main St
Middletown, NY 10940
Phone (845) 341-0213

111 Maltese Dr
Middletown, NY 10940

1219 Dolsontown Rd
Middletown, NY 10940
Phone (845) 344-1899

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678

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": "1498780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1649791518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 MALTESE DR",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402141",
            "telephone_number": "845-342-4774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1219 DOLSONTOWN RD",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109404749",
            "telephone_number": "845-344-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STABACK",
        "first_name": "MATTHEW",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-30",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "048606",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS LICENSE",
            "identifier": "048606",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.