Matthew Ray Anderson, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

5502002547 Issued in MI

Practice address

23770 Hospital St
Cassopolis, MI 49031-9699

Phone

(269) 445-3801

NPI assigned

Jul 12, 2021

Last updated

Jul 12, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: manderson@ccmcf.org

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

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1821660770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52465 SANTA MONICA DR",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465309652",
            "telephone_number": "574-323-3030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23770 HOSPITAL ST",
            "city": "CASSOPOLIS",
            "state": "MI",
            "postal_code": "490319699",
            "telephone_number": "269-445-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MATTHEW",
        "middle_name": "RAY",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-12",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502002547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTA LICENSE #",
            "identifier": "5502002547",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "manderson@ccmcf.org",
            "affiliation": "N",
            "endpointDescription": "Therapy Program Manager - secure email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "23770 Hospital St",
            "city": "Cassopolis",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490319699",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Heather Fergus Abbott, LPC
• Kristin Deana Acosta, B.S, CAADC-DP
• Dawn K Adam
• Jamie Elizabeth Ailes, LLMSW
• Madison R Anderson, DDS
• Bashar Arsanos, DMD
• Anne Erin Augustyn, PT
• Darcie Ball, LLMSW
• Mariah Linn Bartrum, PTA
• Alina Anna Bejoy

• Physical Therapy Assistant in Cassopolis, MI
• Providers in Cassopolis, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.