NPIMap

Organization Active NPI

Chiropractic Performance Center, PA

  • Medical Specialty Clinic/Center
  • Sartell, MN
National Provider Identifier
1144429283
Registry record updated Jan 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
786 Issued in MN
Legal business name
CHIROPRACTIC PERFORMANCE CENTER, PA
Practice address
2380 Troop Drive
Sutie 201
Sartell, MN 56377-4637
Phone
(320) 255-0961
Fax
(320) 258-4001
NPI assigned
Jul 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2017

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

Authorized official

Name
Dr. Sara Jean Cuperus, D.C.NPI 1528064342
Title
Owner
Phone
(320) 255-0961

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 786 MN Primary

Addresses

Primary practice location

2380 Troop Drive
Sutie 201
Sartell, MN 56377-4637

Mailing address

2380 Troop Drive
Suite 201
Sartell, MN 56377-4637
Phone (320) 255-0961

Other identifiers 6

IdentifierTypeStateIssuer
350002734OtherMNMEDICARE INDIVIDUAL #
332J9KLOtherMNBCBS INDIVIDUAL #
331J2CHOtherMNBCBS - CLINIC #
777641100MedicaidMN
965001033012OtherMNPREFERRED ONE
C03940OtherMNMEIDCARE CLINIC #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050603000107 MN Part B Supplier - Clinic/Group Practice 2860435633 Receives reassigned benefits from 4 practitioners
Practice locations: Sartell, MN

National Provider Directory

National Provider Directory

Locations

1733 Pine Cone Rd S
Ste 1100
Sartell, MN 56377
Phone (320) 255-0961

218 N Benton Dr
Sauk Rapids, MN 56379
Phone (320) 255-0961

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483488000000",
    "number": "1144429283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2380 TROOP DRIVE",
            "address_2": "SUITE 201",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563774637",
            "telephone_number": "320-255-0961",
            "fax_number": "320-258-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2380 TROOP DRIVE",
            "address_2": "SUTIE 201",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563774637",
            "telephone_number": "320-255-0961",
            "fax_number": "320-258-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIROPRACTIC PERFORMANCE CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-17",
        "last_updated": "2017-01-04",
        "status": "A",
        "authorized_official_last_name": "CUPERUS",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "320-255-0961",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MN",
            "license": "786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL #",
            "identifier": "350002734",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS INDIVIDUAL #",
            "identifier": "332J9KL",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - CLINIC #",
            "identifier": "331J2CH",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "777641100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "965001033012",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEIDCARE CLINIC #",
            "identifier": "C03940",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sartell, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2017; 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.