Mattie Rose Carter

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070025735 Issued in IL

Practice address

126 S 1St St
Vandalia, IL 62471-2803

Phone

(618) 283-1634

Fax

(618) 283-0423

NPI assigned

Mar 23, 2021

Sex

Female

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

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Transforming Physical Therapy LTDGroup PAC ID 4587142393, 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 and National Provider Directory roles.

• Transforming Physical Therapy LTD

  • Physical Therapy Clinic/Center
  • Vandalia, IL
  • NPI 1295697878

  IL, Physical Therapist

  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1616457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681171200000",
    "number": "1922684653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 S 1ST ST",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624712803",
            "telephone_number": "618-283-1634",
            "fax_number": "618-283-1634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 S 1ST ST",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624712803",
            "telephone_number": "618-283-1634",
            "fax_number": "618-283-0423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARTER",
        "first_name": "MATTIE",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-23",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070025735",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "070025735",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Gregory Brunk, D.M.D.
• Robert Butts, MD
• Cains Drug Store Inc
• Cains Drug Store Inc
• Alivia Cao, DDS
• Carl A Castle, DO
• Kevin Jay Childers, OD
• Jeremy R Clark, D.C.
• Community Resource Center
• Community Resource Center Inc.

• All providers in Vandalia, IL
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.