Individual provider Active NPI

Brian Allen Borchardt, PT

  • Pediatric Physical Therapist
  • Horace, ND
National Provider Identifier
1053468223
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
1121 Issued in ND
Practice address
7119 Maple LN
Horace, ND 58047-4714
Phone
(701) 281-1864
Fax
(701) 281-1924
NPI assigned
Jan 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X 1121 ND Primary
Pediatric Physical Therapist 2251P0200X 6775 MN

Addresses

Primary practice location

7119 Maple LN
Horace, ND 58047-4714

Mailing address

7119 Maple LN
Horace, ND 58047-4714
Phone (701) 281-1864

Other identifiers 7

IdentifierTypeStateIssuer
23319OtherNDND BLUE CROSS BLUE SHIELD
821945OtherAMERICAS PPO
64-05520OtherAETNA
64-05520OtherMEDICA, UNITED HEALTHCARE
51319MedicaidND
HP50726OtherHEALTH PARTNERS
9075049OtherPRIVATE HEALTHCARE SYSTEM

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
6775MNMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Abc Pediatric Physical Therapy, LTD. Past Accepting new patients

Organizations & group practices 1

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": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053468223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7119 MAPLE LN",
            "city": "HORACE",
            "state": "ND",
            "postal_code": "580474714",
            "telephone_number": "701-281-1864",
            "fax_number": "701-281-1924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7119 MAPLE LN",
            "city": "HORACE",
            "state": "ND",
            "postal_code": "580474714",
            "telephone_number": "701-281-1864",
            "fax_number": "701-281-1924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORCHARDT",
        "first_name": "BRIAN",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "ND",
            "license": "1121",
            "primary": true
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "MN",
            "license": "6775",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND BLUE CROSS BLUE SHIELD",
            "identifier": "23319",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAS PPO",
            "identifier": "821945",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "64-05520",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA, UNITED HEALTHCARE",
            "identifier": "64-05520",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "51319",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP50726",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE HEALTHCARE SYSTEM",
            "identifier": "9075049",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Horace, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.