Active NPI
Kendra Shirley Mathews
- Physical Medicine & Rehabilitation Physician
- White Lake, MI
National Provider Identifier
1699400457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 5502000566
- Practice address
- 10770 Elizabeth Lake Rd
White Lake, MI 48386-2136 - Phone
- (248) 618-4100
- NPI assigned
- Jul 17, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 5502000566 | MI | Primary |
Addresses
Primary practice location
10770 Elizabeth Lake Rd
White Lake, MI 48386-2136
Mailing address
5235 Whipple Lake Rd
Clarkston, MI 48348-3054
Phone (248) 390-9553
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | 2483909553 | Direct | |
| CONNECT URL | Work | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5502000566 | MI | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658016000000",
"number": "1699400457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5235 WHIPPLE LAKE RD",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483483054",
"telephone_number": "248-390-9553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10770 ELIZABETH LAKE RD",
"city": "WHITE LAKE",
"state": "MI",
"postal_code": "483862136",
"telephone_number": "248-618-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHEWS",
"first_name": "KENDRA",
"middle_name": "SHIRLEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-17",
"last_updated": "2022-07-17",
"certification_date": "2022-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "MI",
"license": "5502000566",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "2483909553",
"affiliation": "N",
"endpointDescription": "Phone",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "10770 Elizabeth Lake Rd",
"city": "White Lake",
"state": "MI",
"country_code": "US",
"postal_code": "483862136",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Work",
"affiliation": "N",
"endpointDescription": "SNF",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "10770 Elizabeth Lake Rd",
"city": "White Lake",
"state": "MI",
"country_code": "US",
"postal_code": "483862136",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in White Lake, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.