Matthew Vidal Fernandez, PT – Physical Therapist

Key facts

NPI: 1851001077
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapist 225100000X
License: PT22009 (NM)
Practice address: 505 N Main Ave
Aztec, NM 87410-1942
Phone: (505) 334-9616
NPI assigned: Nov 29, 2022
Sex: Male
Sole proprietor: No

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.

Physical Therapy & Sports Medicine of Northern New Mexico, Inc. Physical Therapist · Aztec, NM · NPI 1306069224

Medicare reassignment Care Compare group NPD NM · PHYSICAL THERAPIST

Medicare Care Compare profile

Specialty: Physical Therapist in Private Practice
Education: Other, 2020
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Physical Therapy and Sports Medicine of Northern New Mexico, Inc. (3 clinicians)

Practice addresses (Care Compare)

505 N Main Ave
Aztec, NM 87410-1942
Phone (505) 334-9616

505 N Main Ave
Aztec, NM 87410-1975

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NM

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20230823000316	NM	Practitioner - Physical Therapist in Private Practice	9931562071	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
PT22009	NM	MD	Physical Therapist

Practice roles

Organization	Specialty	Status	New patients
Physical Therapy & Sports Medicine of Northern New Mexico, Inc.	Physical Therapist	Current since Jul 1, 2023	Accepting new patients

Locations

505 N Main Ave
Aztec, NM 87410
Phone (505) 334-9616

660A E Broadway Ave
Bloomfield, NM 87413
Phone (505) 632-4550

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapist	225100000X	PT22009	NM	Yes

Addresses

Primary practice location

505 N Main Ave
Aztec, NM 87410-1942

Mailing address

2201 N Tucker Ave Apt 1
Farmington, NM 87401-8960

Other providers in Aztec, NM

All providers in Aztec, NM · Physical Therapist in New Mexico

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (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.