Individual provider Active NPI

Angela Kezar

  • Occupational Therapist
  • Saint Paul, MN
National Provider Identifier
1316491970
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
105115 Issued in MN
Practice address
435 Phalen Blvd
Saint Paul, MN 55130-5302
Phone
(651) 254-3200
NPI assigned
Aug 11, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 105115 MN Primary

Addresses

Primary practice location

435 Phalen Blvd
Saint Paul, MN 55130-5302

Mailing address

814 River LN
Anoka, MN 55303-2807
Phone (763) 567-0219

Other practice location 1

1710 Suburban Ave
Saint Paul, MN 55106-6636
Phone (651) 254-3200

Other practice location 2

640 Jackson St
Rehabilitation Institute
Saint Paul, MN 55101-2502
Phone (651) 254-2097

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170309001725 MN Practitioner - Occupational Therapist in Private Practice 3274817358 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
105115MNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Regions Hospital CurrentSince Apr 1, 2017 Accepting new patients
Regions Hospital Current Accepting new patients
Regions Hospital CurrentSince Apr 1, 2017 Accepting new patients

Locations

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

435 Phalen Blvd
Saint Paul, MN 55130
Phone (651) 254-3200

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

1710 Suburban Ave
Saint Paul, MN 55106
Phone (651) 254-3200

Organizations & group practices 4

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": "1470873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1316491970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "814 RIVER LN",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553032807",
            "telephone_number": "763-567-0219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 PHALEN BLVD",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551305302",
            "telephone_number": "651-254-3200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1710 Suburban Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551066636",
            "country_code": "US",
            "telephone_number": "651-254-3200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "640 Jackson St",
            "address_2": "Rehabilitation Institute",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551012502",
            "country_code": "US",
            "telephone_number": "651-254-2097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEZAR",
        "first_name": "ANGELA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-11",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "105115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.