NPIMap

Organization Active NPI

Dynamic Connections, Inc.

  • Cognitive & Behavioral Psychologist
  • Maplewood, MN
National Provider Identifier
1265791503
Registry record updated Aug 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
Legal business name
DYNAMIC CONNECTIONS, INC.
Practice address
2495 Maplewood Dr Ste 312
Maplewood, MN 55109-1985
Phone
(651) 760-3109
Fax
(651) 967-9417
NPI assigned
May 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2020

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

Authorized official

Name
Mrs. Kristi Kay Worrell, OTR/L, RDI (C)CERTNPI 1942344544
Title
Executive Director
Phone
(651) 760-3109

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
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X Primary
Rehabilitation Clinic/Center 261QR0400X

Addresses

Primary practice location

2495 Maplewood Dr Ste 312
Maplewood, MN 55109-1985

Mailing address

2495 Maplewood Dr Ste 312
Maplewood, MN 55109-1985
Phone (651) 760-3109

Other practice location 1

2905 Country Dr
suite 105
Little Canada, MN 55117-2627
Phone (651) 760-3111 ext. 3109

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150402001417 MN Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6507183456 Receives reassigned benefits from 2 practitioners
Practice locations: Maplewood, MN
O20240828003636 MN Part B Supplier - Clinic/Group Practice 6507183456 Receives reassigned benefits from 1 practitioner
Practice locations: Maplewood, MN

National Provider Directory

National Provider Directory

Locations

2905 Country Dr
Ste 105
Little Canada, MN 55117
Phone (651) 216-2601

2495 Maplewood Dr N
Ste 312
Maplewood, MN 55109
Phone (651) 760-3109

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1336348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598227200000",
    "number": "1265791503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2495 MAPLEWOOD DR STE 312",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091985",
            "telephone_number": "651-760-3109",
            "fax_number": "651-967-9417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2495 MAPLEWOOD DR STE 312",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091985",
            "telephone_number": "651-760-3109",
            "fax_number": "651-967-9417"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2905 Country Dr",
            "address_2": "suite 105",
            "address_purpose": "LOCATION",
            "city": "Little Canada",
            "state": "MN",
            "postal_code": "551172627",
            "country_code": "US",
            "telephone_number": "651-760-3111 x3109",
            "fax_number": "877-780-1107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DYNAMIC CONNECTIONS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-07",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-20",
        "status": "A",
        "authorized_official_last_name": "WORRELL",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-760-3109",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OTR/L, RDI (C)CERT"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maplewood, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; 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.