Individual provider Active NPI

Matthew Lisk, ATC, DPT

  • Physical Therapist
  • Clayton, NC
National Provider Identifier
1730444522
Registry record updated Jan 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
P13758 Issued in NC
Practice address
166 Springbrook Ave Ste 201
Clayton, NC 27520-8520
Phone
(828) 492-0592
Fax
(410) 648-4878
NPI assigned
Jul 9, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X P13758 NC Primary

Addresses

Primary practice location

166 Springbrook Ave Ste 201
Clayton, NC 27520-8520

Mailing address

350 New Fidelity CT
Garner, NC 27529-2665
Phone (919) 258-2714

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120813000731 NC Practitioner - Physical Therapist in Private Practice 8022264746 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Brody School of Medicine at East Carolina University, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Activcare Physical Therapy, LLCGroup PAC ID 8628027471, 126 clinicians

Practice addresses (Care Compare)

1417 S Pollock St
Selma, NC 27576-3405
Phone (919) 300-5040

166 Springbrook Ave
Suite 201
Clayton, NC 27520-8520
Phone (919) 535-8461

Merit-based Incentive Payment System (MIPS)

Final score
88.67 of 100Reported as group
Quality
85.21
Promoting interoperability
99
Improvement activities
40
Cost
77.85

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13758NCMDDentist
P13758NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Activcare Physical Therapy, LLC Physical Therapist CurrentSince Jul 20, 2012 Accepting new patients

Locations

1801 Olive Chapel Rd
Ste 103
Apex, NC 27502
Phone (919) 373-5353

166 Springbrook Ave
Ste 201
Clayton, NC 27520
Phone (919) 535-8461

350 New Fidelity Ct
Garner, NC 27529
Phone (919) 373-2919

3410 Executive Dr
Ste 205
Raleigh, NC 27609
Phone (919) 322-0042

3200 Blue Ridge Rd
Ste 122
Raleigh, NC 27612
Phone (919) 781-0018

Interoperability endpoints

  • Direct secure messaging: matthew.lisk.p12@direct.athleticoltd.nextgenshare.com

Organizations & group practices 1

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": "1341792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1730444522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 NEW FIDELITY CT",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275292665",
            "telephone_number": "919-258-2714",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 SPRINGBROOK AVE STE 201",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275208520",
            "telephone_number": "828-492-0592",
            "fax_number": "410-648-4878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISK",
        "first_name": "MATTHEW",
        "credential": "ATC, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-09",
        "last_updated": "2022-01-03",
        "certification_date": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P13758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clayton, NC

Sources for this page

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