Active NPI
Jason Breuer
- Occupational Therapist
- Mahnomen, MN
National Provider Identifier
1295468650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 102030
- Practice address
- 414 W Jefferson Ave
Mahnomen, MN 56557-4912 - Phone
- (605) 541-1145
- NPI assigned
- Jul 5, 2022
- Last updated
- Jul 5, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 102030 | MN | Primary |
Addresses
Primary practice location
414 W Jefferson Ave
Mahnomen, MN 56557-4912
Mailing address
500 Cross St
Big Stone City, SD 57216-8237
Phone (605) 541-1140
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102030 | MN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656979200000",
"number": "1295468650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 CROSS ST",
"city": "BIG STONE CITY",
"state": "SD",
"postal_code": "572168237",
"telephone_number": "605-541-1140",
"fax_number": "605-541-0109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "414 W JEFFERSON AVE",
"city": "MAHNOMEN",
"state": "MN",
"postal_code": "565574912",
"telephone_number": "605-541-1145"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREUER",
"first_name": "JASON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-05",
"last_updated": "2022-07-05",
"certification_date": "2022-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "102030",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mahnomen, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.