Individual provider Active NPI

Thomas Ebert, DPT

  • Physical Therapist
  • Maplewood, MN
National Provider Identifier
1316468879
Registry record updated May 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
1856 Beam Ave Ste 100
Maplewood, MN 55109-1162
Phone
(763) 201-8191
NPI assigned
Jul 5, 2017
Last updated
May 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2021

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 NU Primary

Addresses

Primary practice location

1856 Beam Ave Ste 100
Maplewood, MN 55109-1162

Mailing address

9645 Grove Cir N Ste 200
Maple Grove, MN 55369-2684
Phone (763) 201-8191

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171005002572 MN Practitioner - Physical Therapist in Private Practice 2860767571 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Interventional Spine and Pain Physicians PAGroup PAC ID 2466606264, 42 clinicians

Practice addresses (Care Compare)

9645 Grove Cir N
Suite 200
Maple Grove, MN 55369-2684
Phone (763) 201-8191

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10813MNMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Interventional Spine and Pain Physicians, PA Physical Therapist CurrentSince Apr 15, 2021 Accepting new patients

Locations

172 Cobblestone Ln
Burnsville, MN 55337
Phone (952) 908-2710

320 Coon Rapids Blvd NW
Ste 100
Coon Rapids, MN 55433
Phone (952) 908-2580

916 Saint Peter Ave E
Delano, MN 55328
Phone (763) 972-9172

7700 France Ave S
Ste 240
Edina, MN 55435
Phone (952) 908-2700

7767 Elm Creek Blvd N
Ste 160
Maple Grove, MN 55369
Phone (763) 391-7522

9600 Upland Ln N
Ste 160
Maple Grove, MN 55369

9645 Grove Cir N
Ste 200
Maple Grove, MN 55369
Phone (763) 300-2193

1856 Beam Ave
#100
Maplewood, MN 55109

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1499212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1316468879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9645 GROVE CIR N STE 200",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553692684",
            "telephone_number": "763-201-8191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1856 BEAM AVE STE 100",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091162",
            "telephone_number": "763-201-8191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERT",
        "first_name": "THOMAS",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-05",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "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 May 13, 2021; 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.