Matthew Profeta, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

033901 Issued in NY

Practice address

2760 Delaware Ave
Kenmore, NY 14217-2702

Phone

(716) 423-2262

Fax

(716) 423-2263

NPI assigned

Jan 6, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Buffalo Rehab Group Physical Therapy and Occupational Therapy PCGroup PAC ID 1355232596, 79 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Buffalo Rehab Group Physical Therapy and Occupational Therapy PC

  • Physical Therapist
  • West Seneca, NY
  • NPI 1548290943
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1420502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618358400000",
    "number": "1720476245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BOX 8000 DEPT 314",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142670002",
            "telephone_number": "716-213-0772",
            "fax_number": "716-324-5004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2760 DELAWARE AVE",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142172702",
            "telephone_number": "716-423-2262",
            "fax_number": "716-423-2263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROFETA",
        "first_name": "MATTHEW",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-06",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1253180",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "25221",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305209005",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "033901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04425389",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Kenmore, NY
• Providers in Kenmore, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; 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.