NPIMap

Individual provider Active NPI

Paul Thomas Tembrock, PT

  • Physical Therapist
  • Saint Cloud, MN
National Provider Identifier
1124193057
Registry record updated Aug 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1478 Issued in MN
Practice address
251 County Road 120
Suite a
Saint Cloud, MN 56303
Phone
(320) 259-5429
Fax
(320) 240-8905
NPI assigned
Nov 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1478 MN Primary

Addresses

Primary practice location

251 County Road 120
Suite a
Saint Cloud, MN 56303

Mailing address

251 County Road 120
Suite a
Saint Cloud, MN 56303
Phone (320) 259-5429

Other identifiers 6

IdentifierTypeStateIssuer
6406241OtherMNMEDICA
6406241OtherMNSELECT CARE
264M1NOOtherMNBLUE CROSS BLUE SHIELD OF MN
6B504TEOtherMNBLUE CROSS BLUE SHIELD
744023500MedicaidMN
HP43507OtherMNHEALTHPARTNERS

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
1478MNMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Star Therapy LTD Physical Therapist Past Accepting new patients
Northern Star Therapy LTD Physical Therapist Past Accepting new patients
Northern Star Therapy LTD Physical Therapist Past Accepting new patients
Northern Star Therapy LTD Physical Therapist Past Accepting new patients

Organizations & group practices 4

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": "1164326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376870400000",
    "number": "1124193057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 COUNTY ROAD 120",
            "address_2": "SUITE A",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "56303",
            "telephone_number": "320-259-5429",
            "fax_number": "320-240-8905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 COUNTY ROAD 120",
            "address_2": "SUITE A",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "56303",
            "telephone_number": "320-259-5429",
            "fax_number": "320-240-8905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEMBROCK",
        "first_name": "PAUL",
        "middle_name": "THOMAS",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-24",
        "last_updated": "2013-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "1478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6406241",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECT  CARE",
            "identifier": "6406241",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MN",
            "identifier": "264M1NO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "6B504TE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "744023500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP43507",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2013; 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.