Individual provider Active NPI

Joseph Urban Quade, P.T.

  • Physical Therapist
  • Cloquet, MN
National Provider Identifier
1134168404
Registry record updated Mar 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6080 Issued in MN
Practice address
1204 Cloquet Ave
Cloquet, MN 55720-1622
Phone
(218) 878-0805
Fax
(218) 878-0794
NPI assigned
Jun 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 25, 2021

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 6080 MN Primary

Addresses

Primary practice location

1204 Cloquet Ave
Cloquet, MN 55720-1622

Mailing address

507 N Blackman Ave
Duluth, MN 55811-5239
Phone (218) 341-1205

Other practice location 1

5704 Miller Trunk Hwy
Hermantown, MN 55811-1238
Phone (218) 878-0805

Other identifiers 2

IdentifierTypeStateIssuer
006R1QUOtherMNBLUE CROSS BLUE SHIELD
561258600MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051012000268 MN Practitioner - Physical Therapist in Private Practice 3072538784 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Park Avenue Therapies Physical Therapist CurrentSince Jan 4, 2021 Accepting new patients
Bodies in Balance of Two Harbors, Inc. Physical Therapist PastSince Jul 15, 2003 Accepting new patients

Locations

1204 Cloquet Ave
Cloquet, MN 55720
Phone (218) 878-0805

5704 Miller Trunk Hwy
Hermantown, MN 55811
Phone (218) 878-0805

Organizations & group practices 2

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": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1134168404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 N BLACKMAN AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558115239",
            "telephone_number": "218-341-1205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 CLOQUET AVE",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201622",
            "telephone_number": "218-878-0805",
            "fax_number": "218-878-0794"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5704 Miller Trunk Hwy",
            "address_purpose": "LOCATION",
            "city": "Hermantown",
            "state": "MN",
            "postal_code": "558111238",
            "country_code": "US",
            "telephone_number": "218-878-0805",
            "fax_number": "218-878-0794",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "QUADE",
        "first_name": "JOSEPH",
        "middle_name": "URBAN",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "6080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "006R1QU",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "561258600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cloquet, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.