Individual provider Active NPI

Michelle King, RPT

  • Physical Therapist
  • Saint Cloud, MN
National Provider Identifier
1194892323
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5416 Issued in MN
Practice address
1717 University Dr SE
Saint Cloud, MN 56304-2023
Phone
(763) 689-5385
NPI assigned
Nov 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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 5416 MN Primary

Addresses

Primary practice location

1717 University Dr SE
Saint Cloud, MN 56304-2023

Mailing address

116 Edward St S
Pierz, MN 56364-4122

Other identifiers 3

IdentifierTypeStateIssuer
6411308OtherMNMEDICA
HP45892OtherMNHEALTH PARTNERS
11D08TAOtherMNBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221102000439 MN Practitioner - Physical Therapist in Private Practice 4082081153 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aegis Group Practice LLCGroup PAC ID 5193036432, 399 clinicians

Practice addresses (Care Compare)

1012 3Rd Ave NE
Little Falls, MN 56345-4647
Phone (320) 434-9641

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5416MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Aegis Group Practice LLC Physical Therapist CurrentSince Sep 23, 2022 Accepting new patients
Aegis Group Practice LLC Physical Therapist CurrentSince Sep 23, 2022 Accepting new patients

Locations

4933 Old Greenwood Rd
Fort Smith, AR 72903

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": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1194892323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 EDWARD ST S",
            "city": "PIERZ",
            "state": "MN",
            "postal_code": "563644122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 UNIVERSITY DR SE",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563042023",
            "telephone_number": "763-689-5385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "MICHELLE",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "5416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6411308",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP45892",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "11D08TA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.