Individual provider Active NPI

Matthew Langworthy

  • Physical Therapist
  • San Diego, CA
National Provider Identifier
1750872768
Registry record updated Jul 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT294466 Issued in CA
Practice address
3405 Kenyon St Ste 212
San Diego, CA 92110
Phone
(619) 523-9874
NPI assigned
May 24, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2018

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 PT294466 CA Primary

Addresses

Primary practice location

3405 Kenyon St Ste 212
San Diego, CA 92110

Mailing address

3760 Convoy St Ste 101
San Diego, CA 92111-3743
Phone (888) 208-8526

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180720000867 CA Practitioner - Physical Therapist in Private Practice 0547517658 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MDRS Spine and Sport IncGroup PAC ID 3274446687, 181 clinicians

Practice addresses (Care Compare)

1020 Tierra del Rey
Suite a 1
Chula Vista, CA 91910-7886
Phone (619) 585-7104

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT294466CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
MDRS Spine & Sport, Inc Physical Therapist CurrentSince Jul 1, 2018 Accepting new patients
MDRS Spine & Sport, Inc Physical Therapist CurrentSince Jul 1, 2018 Accepting new patients

Locations

1020 Tierra del Rey
Ste A1
Chula Vista, CA 91910
Phone (619) 585-7104

72880 Fred Waring Dr
Ste B7
Palm Desert, CA 92260
Phone (760) 340-4050

3760 Convoy St
Ste 101
San Diego, CA 92111
Phone (858) 264-1434

3405 Kenyon St
Ste 306
San Diego, CA 92110
Phone (303) 594-3364

3405 Kenyon St
Ste 212
San Diego, CA 92110
Phone (619) 523-9874

1801 Cleveland Ave
Ste B
Santa Rosa, CA 95401
Phone (707) 526-4180

Organizations & group practices 2

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": "1527120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530576000000",
    "number": "1750872768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3760 CONVOY ST STE 101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921113743",
            "telephone_number": "888-208-8526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3405 KENYON ST STE 212",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92110",
            "telephone_number": "619-523-9874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANGWORTHY",
        "first_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-24",
        "last_updated": "2018-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT294466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2018; 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.