Individual provider Active NPI

Matthew Paul Buch, PT

  • Physical Therapist
  • De Pere, WI
National Provider Identifier
1891346672
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
14872 Issued in WI
Practice address
920 Main Ave Ste B
De Pere, WI 54115-1306
Phone
(920) 403-0085
Fax
(920) 278-5368
NPI assigned
Sep 24, 2019
Last updated
Oct 31, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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 14872 WI Primary

Addresses

Primary practice location

920 Main Ave Ste B
De Pere, WI 54115-1306

Mailing address

920 Main Ave Ste B
De Pere, WI 54115-1306
Phone (920) 403-0085

Other identifiers 1

IdentifierTypeStateIssuer
100093827MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14872WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc Physical Therapist CurrentSince Oct 20, 2023 Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Aug 28, 2023 Accepting new patients
Oconto Hospital & Medical Center Inc Current Accepting new patients
Total Pursuit Physical Therapy & Performance CurrentSince Nov 3, 2024 Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients

Locations

920 Main Ave
#B
De Pere, WI 54115
Phone (920) 336-2822

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

575 4th St
Kewaunee, WI 54216
Phone (920) 388-4640

3415 Custer St
Ste D
Manitowoc, WI 54220
Phone (920) 652-9310

2820 Roosevelt Rd
Marinette, WI 54143
Phone (715) 330-6171

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1569283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1891346672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 MAIN AVE STE B",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541151306",
            "telephone_number": "920-403-0085",
            "fax_number": "920-278-5368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 MAIN AVE STE B",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541151306",
            "telephone_number": "920-403-0085",
            "fax_number": "920-278-5368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCH",
        "first_name": "MATTHEW",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-24",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "14872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100093827",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in De Pere, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; 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.