Individual provider Active NPI

Jessica Lynn Olderness, PT

  • Physical Therapist
  • Brooklyn Park, MN
National Provider Identifier
1265549950
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5998 Issued in MN
Practice address
5601 96TH Ave N Ste 100
Brooklyn Park, MN 55443-4505
Phone
(763) 786-9543
Fax
(763) 786-3320
NPI assigned
Aug 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

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 5998 MN Primary

Addresses

Primary practice location

5601 96TH Ave N Ste 100
Brooklyn Park, MN 55443-4505

Mailing address

4200 Dahlberg Dr Ste 300
Golden Valley, MN 55422-4841
Phone (952) 512-5600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060315000262 MN Practitioner - Physical Therapist in Private Practice 1355358466 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infinite Health Collaborative, PAGroup PAC ID 1052225042, 815 clinicians

Practice addresses (Care Compare)

5601 96TH Ave N
Suite 200
Brooklyn Park, MN 55443-4505
Phone (763) 786-9543

Merit-based Incentive Payment System (MIPS)

Final score
91.79 of 100Reported as group
Quality
95.08
Improvement activities
40
Cost
81.67

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5998MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services CurrentSince Sep 1, 2000 Accepting new patients
Fairview Health Services CurrentSince Sep 1, 2000 Accepting new patients
Fairview Express Care Current Accepting new patients
Infinite Health Collaborative, PA Physical Therapist CurrentSince Aug 29, 2022 Accepting new patients
Fairview Health Services Current Accepting new patients
Infinite Health Collaborative, PA CurrentSince Aug 29, 2022 Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients
St. Croix Orthopaedics, PA Past Accepting new patients

Locations

15650 Cedar Ave
Ste 160
Apple Valley, MN 55124
Phone (952) 997-4170

5601 96th Ave N
Ste 200
Brooklyn Park, MN 55443
Phone (763) 786-9543

5601 96th Ave N
Ste 100
Brooklyn Park, MN 55443
Phone (763) 786-9543

4200 Dahlberg Dr
Ste 300
Minneapolis, MN 55422
Phone (952) 512-5600

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

2805 Campus Dr
Ste 115
Plymouth, MN 55441
Phone (763) 551-9511

16800 37th Pl N
#100
Plymouth, MN 55446

15655 37th Ave N
Ste 250
Plymouth, MN 55446
Phone (763) 316-0750

Organizations & group practices 8

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": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1265549950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 DAHLBERG DR STE 300",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224841",
            "telephone_number": "952-512-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 96TH AVE N STE 100",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554434505",
            "telephone_number": "763-786-9543",
            "fax_number": "763-786-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLDERNESS",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "5998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; 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.