NPIMap

Organization Active NPI

Alpine Physical Therapy & Wellness Center, Inc

  • Physical Therapy Clinic/Center
  • Alpine, CA
National Provider Identifier
1669576930
Registry record updated Jan 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
ALPINE PHYSICAL THERAPY & WELLNESS CENTER, INC
Practice address
2549 Alpine Blvd
Alpine, CA 91901-3950
Phone
(619) 445-3168
Fax
(619) 445-5368
NPI assigned
Sep 8, 2006
Last updated
Jan 13, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2012

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

Authorized official

Name
Mr. Matthew Daniel Kraemer, PT NCSNPI 1700988433
Title
President
Phone
(619) 445-3168

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

2549 Alpine Blvd
Alpine, CA 91901-3950

Mailing address

2549 Alpine Blvd
Alpine, CA 91901-3950
Phone (619) 445-3168

Other identifiers 2

IdentifierTypeStateIssuer
PT0211000MedicaidCA
GPT001571MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031208001104 CA Part B Supplier - Clinic/Group Practice 8022914498 Receives reassigned benefits from 4 practitioners
Practice locations: Julian, CA; Alpine, CA

National Provider Directory

National Provider Directory

Locations

1392 Tavern Rd
#1
Alpine, CA 91901
Phone (619) 445-3168

1620 Alpine Blvd
Ste 211
Alpine, CA 91901
Phone (619) 445-0600

2549 Alpine Blvd
Alpine, CA 91901
Phone (619) 445-3168

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326412800000",
    "number": "1669576930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2549 ALPINE BLVD",
            "city": "ALPINE",
            "state": "CA",
            "postal_code": "919013950",
            "telephone_number": "619-445-3168",
            "fax_number": "619-445-5368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2549 ALPINE BLVD",
            "city": "ALPINE",
            "state": "CA",
            "postal_code": "919013950",
            "telephone_number": "619-445-3168",
            "fax_number": "619-445-5368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALPINE PHYSICAL THERAPY & WELLNESS CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2012-01-13",
        "status": "A",
        "authorized_official_last_name": "KRAEMER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-445-3168",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT NCS"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PT0211000",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GPT001571",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; 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.