Matthew Potter, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

34853 Issued in FL

Practice address

105 Mariner Health Way Ste 213
Saint Augustine, FL 32086-3251

Phone

(904) 217-4259

Fax

(904) 217-4251

NPI assigned

May 4, 2020

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

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Saint Augustine Rehabilitation Specialists LLCGroup PAC ID 8426107293, 38 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.

• Saint Augustine Rehabilitation Specialists LLC

  • Physical Therapist
  • St Augustine, FL
  • NPI 1548407521
  Medicare reassignment Care Compare group NPD
• Coastal Communities Physician Network, Inc.

  • Health Maintenance Organization
  • San Luis Obispo, CA
  • NPI 1275735011
  NPD (past)

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

{
    "created_epoch": "1588550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1902427693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "618 MARISOL DR",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321685356",
            "telephone_number": "321-525-0612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MARINER HEALTH WAY STE 213",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320863251",
            "telephone_number": "904-217-4259",
            "fax_number": "904-217-4251"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "618 Marisol Dr",
            "address_purpose": "LOCATION",
            "city": "New Smyrna Beach",
            "state": "FL",
            "postal_code": "321685356",
            "country_code": "US",
            "telephone_number": "321-525-0612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POTTER",
        "first_name": "MATTHEW",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-04",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "34853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adriano Portes, RPH
• Danielle Marie Portuondo, RD, LDN
• Lindsey Porubcan, PA-C
• Frederick John Post, LMHC
• Pamela Henderson Postell, NP
• Marshall Poulin, APRN
• Nathan Pouliot, PHARM D
• Fred Joe Powell, M.D.
• Sean Michael Powell, PA-C
• Tera L Powell

• Physical Therapist in Saint Augustine, FL
• Providers in Saint Augustine, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.