NPIMap

Organization Active NPI

Orthopedic & Sports Physical Therapy Inc.

  • Physical Therapist
  • Hankinson, ND
National Provider Identifier
1225215338
Registry record updated Aug 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1180 Issued in ND
Legal business name
ORTHOPEDIC & SPORTS PHYSICAL THERAPY INC.
Practice address
112 5TH St SW
Hankinson, ND 58041-4417
Phone
(701) 242-7323
Fax
(701) 242-7797
NPI assigned
Jan 31, 2008
Last updated
Aug 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2015

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

Authorized official

Name
Mrs. Shawn Marie Krause-Roberts, MPTNPI 1861449019
Title
Physical Therapist, President
Phone
(218) 641-7725

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1180 ND Primary
Physical Therapist 225100000X 6521 MN

Addresses

Primary practice location

112 5TH St SW
Hankinson, ND 58041-4417

Mailing address

430 5TH St N
Breckenridge, MN 56520-1426
Phone (218) 641-7725

Other identifiers 5

IdentifierTypeStateIssuer
26722OtherNDND BCBS
64-06755OtherMNMEDICA
03N04OROtherMNMN BCBS
54541MedicaidND
DD3739OtherNDRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060627000363 ND Part B Supplier - Clinic/Group Practice 7416901921 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
Practice locations: Hankinson, ND

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Orthopedic and Sports Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438560000000",
    "number": "1225215338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 5TH ST N",
            "city": "BRECKENRIDGE",
            "state": "MN",
            "postal_code": "565201426",
            "telephone_number": "218-641-7725",
            "fax_number": "218-641-6625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 5TH ST SW",
            "city": "HANKINSON",
            "state": "ND",
            "postal_code": "580414417",
            "telephone_number": "701-242-7323",
            "fax_number": "701-242-7797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC & SPORTS PHYSICAL THERAPY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-31",
        "last_updated": "2015-08-03",
        "status": "A",
        "authorized_official_last_name": "KRAUSE-ROBERTS",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST, PRESIDENT",
        "authorized_official_telephone_number": "218-641-7725",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ND",
            "license": "1180",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "6521",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND BCBS",
            "identifier": "26722",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "64-06755",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BCBS",
            "identifier": "03N04OR",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54541",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DD3739",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hankinson, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2015; 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.