Scot Gubbels
Individual provider Active NPI Chiropractor · Lakeville, MN
NPI 1124763230 · NPPES record last updated Jan 22, 2024
Key facts
- NPI
- 1124763230
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 6982 (MN)
- Practice address
- 17316 Kenyon Ave Ste 103
Lakeville, MN 55044-6910 - Phone
- (952) 236-0767
- NPI assigned
- May 3, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
14205 Alabama Ave S
Savage, MN 55378-4434
17316 Kenyon Ave
Lakeville, MN 55044-6909
Phone (952) 236-0767
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN, NE
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230704000454 | MN | Practitioner - Chiropractic | 1456710805 | Practice locations: Lakeville, MN |
| I20240327000606 | NE | Practitioner - Chiropractic | 1456710805 | Practice locations: Wayne, NE |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2181 | NE | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Scotty G LLC | Chiropractor | Current | Accepting new patients |
| Upright Health PLLC | Current |
Accepting new patients |
Locations
17316 Kenyon Ave
Ste 103
Lakeville, MN 55044
Phone (952) 236-0767
17316 Kenyon Ave
Lakeville, MN 55044
Phone (952) 236-0767
214 N Pearl St
Wayne, NE 68787
Phone (402) 369-9664
Interoperability endpoints
- scot.gubbels.1@29676.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 6982 | MN | Yes |
Addresses
Primary practice location
17316 Kenyon Ave Ste 103
Lakeville, MN 55044-6910
Mailing address
17316 Kenyon Ave Ste 103
Lakeville, MN 55044-6910
Phone (952) 236-0767
Other providers in Lakeville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.