Jordan Braun, DPT
Individual provider Active NPI Physical Therapist · Williston, ND
NPI 1154795136 · NPPES record last updated Nov 13, 2015
Key facts
- NPI
- 1154795136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2254 (ND)
- Practice address
- 512 Main St
Williston, ND 58801-5316 - Phone
- (701) 774-0320
- Fax
- (701) 774-0337
- NPI assigned
- Nov 13, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Elite Specialty Clinics, Inc.
Practice addresses (Care Compare)
512 Main St
Williston, ND 58801-5316
Phone 7017740320740320
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151202002277 | ND | Practitioner - Physical Therapist in Private Practice | 7012217722 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2254 | ND | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elite Specialty Clinics, Inc. | Current |
Accepting new patients | |
| Elite Specialty Clinics, Inc. | Current |
Accepting new patients |
Locations
512 Main St
Williston, ND 58801
Phone (701) 774-0320
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2254 | ND | Yes |
Addresses
Primary practice location
512 Main St
Williston, ND 58801-5316
Mailing address
PO Box 6358
Williston, ND 58802-6358
Phone (701) 774-0320
Other providers in Williston, ND
- Kari Elizabeth Boston
- Shelby Lynne Bowlds
- Susan Mae Bradford
- Alina Bradish
- Emilee T Brannan
- Cami S Bren
- Tamrin Brenno-Fagerland
- Danielle J Brenno-Watterud
- Tammie Brock
- Deborah L Bronson
All providers in Williston, ND · Physical Therapist in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2015. 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.