Individual provider Active NPI

Jessica Skelly, DPT

  • Physical Therapist
  • Maplewood, MN
National Provider Identifier
1396115614
Registry record updated Feb 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
9980 Issued in MN
Practice address
1570 Beam Ave
Suite 200
Maplewood, MN 55109-1166
Phone
(651) 232-7820
NPI assigned
Sep 29, 2015
Last updated
Feb 8, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2019

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 9980 MN Primary

Addresses

Primary practice location

1570 Beam Ave
Suite 200
Maplewood, MN 55109-1166

Mailing address

1570 Beam Ave
Suite 200
Maplewood, MN 55109-1166
Phone (651) 232-7820

Other names 1

  • Jessica Mohrbacher Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160212000020 MN Practitioner - Physical Therapist in Private Practice 1759685761 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

3305 Central Park Village Dr
Suite 130
Eagan, MN 55121-7707
Phone (651) 406-8868

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9980MNMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services CurrentSince Aug 1, 2020 Accepting new patients
Fairview Express Care CurrentSince Oct 1, 2023 Accepting new patients
Fairview Express Care CurrentSince Oct 1, 2023 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Health Services CurrentSince Aug 1, 2020 Accepting new patients
Healtheast Outpatient Services, LLC Physical Therapist CurrentSince Sep 1, 2015 Accepting new patients

Locations

3305 Central Park Village Dr
Ste 130
Eagan, MN 55121
Phone (651) 406-8701

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

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

1570 Beam Ave
Ste 200
Saint Paul, MN 55109
Phone (651) 232-7820

1390 University Ave W
Saint Paul, MN 55104
Phone (651) 232-4800

1825 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-6700

Organizations & group practices 7

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": "1443484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549584000000",
    "number": "1396115614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 BEAM AVE",
            "address_2": "SUITE 200",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091166",
            "telephone_number": "651-232-7820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 BEAM AVE",
            "address_2": "SUITE 200",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091166",
            "telephone_number": "651-232-7820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKELLY",
        "first_name": "JESSICA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-29",
        "last_updated": "2019-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "9980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "MOHRBACHER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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 Feb 8, 2019; 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.