Matthew Quinn Ezernack

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

11530 Issued in LA

Practice address

4080 Nelson Rd Ste 500
Lake Charles, LA 70605-2440

Phone

(337) 494-7546

NPI assigned

May 23, 2023

Last updated

May 23, 2023By 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

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Calcasieu Therapy Group LLCGroup PAC ID 8325270358, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Calcasieu Therapy Group LLC

  • Physical Therapist
  • Moss Bluff, LA
  • NPI 1487085320
  Medicare reassignment Care Compare group NPD
• Iowa Therapy Group LLC

  • Physical Therapist
  • Iowa, LA
  • NPI 1578617924
  Medicare reassignment NPD
• Lake Charles Sports & Rehab

  • Physical Therapist
  • Lake Charles, LA
  • NPI 1194301317
  Medicare reassignment NPD
• Southwest Louisiana Sports and Rehabilitation Center, LLC

  • Physical Therapist
  • Lake Charles, LA
  • NPI 1841357761
  Medicare reassignment NPD
• Thibodeaux, Albro & Touchet Therapy Group, LLC

  • Physical Therapist
  • Jennings, LA
  • NPI 1104973262
  Medicare reassignment NPD
• Action Potential Physical Therapy - Moss Bluff, LLC

  • Physical Therapy Clinic/Center
  • Lake Charles, LA
  • NPI 1912843855
  NPD (past)
• Kinder Therapy Group, LLC

  • Physical Therapist
  • Kinder, LA
  • NPI 1912780578
  NPD (past)

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

{
    "created_epoch": "1684800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684800000000",
    "number": "1912699547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2923 SUMMER PLACE DR",
            "city": "SULPHUR",
            "state": "LA",
            "postal_code": "706630758",
            "telephone_number": "337-309-0925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4080 NELSON RD STE 500",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706052440",
            "telephone_number": "337-494-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZERNACK",
        "first_name": "MATTHEW",
        "middle_name": "QUINN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-23",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "LA",
            "license": "11530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Executive Medical Clinic of Lake Charles
• Extraordinary Health Inc.
• Extraordinary Healthcare, LLC
• Eye Clinic a Professional Medical Corp.
• Eyemart Express LLC
• Ivana Ezeude, MD
• Megan A Fabian, LPC
• Chad David Fairchild, M.D.
• Jude Paul Fairchild, D.D.S.
• Tammy Lynn Fairchild, MD

• Physical Medicine & Rehabilitation Physician in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Physical Medicine & Rehabilitation Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; 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.