Michael John Doherty, ATC, LAT, DPT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

36002268A Issued in IN

Practice address

10133 Devonshire LN
Munster, IN 46321-4376

Phone

(219) 381-1861

NPI assigned

May 11, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bentonville Physical Therapy SpecialistsGroup PAC ID 7911270582, 2 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.

• Bentonville Physical Therapy Specialists

  • Orthopedic Physical Therapist
  • Bentonville, AR
  • NPI 1437696440
  Medicare reassignment Care Compare group NPD
• Institute for Advanced Medicine, PA

  • Physical Therapy Clinic/Center
  • Bentonville, AR
  • NPI 1477058121
  NPD (past)

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494460800000",
    "number": "1730616574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10133 DEVONSHIRE LN",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463214376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10133 DEVONSHIRE LN",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463214376",
            "telephone_number": "219-381-1861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOHERTY",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "credential": "ATC, LAT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-11",
        "last_updated": "2017-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "36002268A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Renee Dobkowski
• Marris Taylor Dobosz, RN
• Erica Dockens, LCSW, RN
• Reina Doetterl
• John Joseph Doherty, P.T., A.T.C.
• Patricia E Donovan, MSW, LSW
• Kathleen Doran
• Devang Doshi, M.D.
• Kalpana H Doshi, M.D.
• Parul H Doshi, MD

• Athletic Trainer in Munster, IN
• Providers in Munster, IN by specialty
• Athletic Trainer in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; 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.