Individual provider Active NPI

Corey Zimmerman, DPT

  • Physical Therapist
  • Grand Forks, ND
National Provider Identifier
1033708524
Registry record updated Dec 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2702 Issued in ND
Practice address
1750 47TH Ave S
Grand Forks, ND 58201-7595
Phone
(701) 757-8700
NPI assigned
Jan 11, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2250 SD
Physical Therapist 225100000X 2702 ND Primary

Addresses

Primary practice location

1750 47TH Ave S
Grand Forks, ND 58201-7595

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-9419

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, ND2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210616003216 SD Practitioner - Physical Therapist in Private Practice 7517367253 Reassigns benefits to 1 organization
I20230817002555 ND Practitioner - Physical Therapist in Private Practice 7517367253 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

1750 47TH Ave S
Grand Forks, ND 58201-7595
Phone (701) 757-8700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2702NDMDPhysical Therapist
2250SDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan Current Accepting new patients
Avera McKennan CurrentSince May 25, 2021 Accepting new patients
Avera McKennan CurrentSince May 25, 2021 Accepting new patients
Sanford Medical Center Fargo CurrentSince Jul 17, 2023 Accepting new patients
Sanford Medical Center Fargo CurrentSince Jul 17, 2023 Accepting new patients
Sanford Medical Center Fargo Past Accepting new patients

Locations

3035 Demers Ave
Grand Forks, ND 58201
Phone (701) 746-6694

1750 47th Ave S
Grand Forks, ND 58201
Phone (701) 757-8700

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

300 W 5th St
Miller, SD 57362
Phone (605) 853-0158

3901 S Marion Rd
Sioux Falls, SD 57106
Phone (605) 323-0879

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1610323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702598400000",
    "number": "1033708524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-9419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 47TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582017595",
            "telephone_number": "701-757-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIMMERMAN",
        "first_name": "COREY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-11",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SD",
            "license": "2250",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ND",
            "license": "2702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.