Individual provider Active NPI

Aaron Charles Proefrock, PT, DPT

  • Physical Therapist
  • Gillette, WY
National Provider Identifier
1194332270
Registry record updated Sep 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
1103 E Boxelder Rd Ste U
Gillette, WY 82718-5582
Phone
(307) 686-8177
NPI assigned
Sep 23, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2020

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 Primary

Addresses

Primary practice location

1103 E Boxelder Rd Ste U
Gillette, WY 82718-5582

Mailing address

1103 E Boxelder Rd Ste U
Gillette, WY 82718-5582
Phone (307) 686-8177

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240613000485 ND Practitioner - Physical Therapist in Private Practice 1052721222 Reassigns benefits to 1 organization
I20240910003459 MN Practitioner - Physical Therapist in Private Practice 1052721222 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Total Balance Physical Therapy and Fitness, LLCGroup PAC ID 8820356991, 37 clinicians

Practice addresses (Care Compare)

1315 1St St
West Fargo, ND 58078-2967
Phone (701) 293-6037

3501 8TH St S
Moorhead, MN 56560-5155
Phone (701) 293-6037

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Total Balance Physical Therapy and Fitness, LLC Physical Therapist CurrentSince May 20, 2024 Accepting new patients
Total Balance Dietitian, LLC PastSince Mar 24, 2024 Accepting new patients

Locations

3501 8th St S
Moorhead, MN 56560
Phone (218) 422-3343

1461 Broadway N
Fargo, ND 58102
Phone (701) 293-6037

2600 52nd Ave S
Fargo, ND 58104
Phone (701) 293-6037

1315 1st St E
West Fargo, ND 58078
Phone (701) 293-6037

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": "1600819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600819200000",
    "number": "1194332270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 E BOXELDER RD STE U",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827185582",
            "telephone_number": "307-686-8177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 E BOXELDER RD STE U",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827185582",
            "telephone_number": "307-686-8177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROEFROCK",
        "first_name": "AARON",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-23",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gillette, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.