Individual provider Active NPI

Carter Philip Kasianov, PT, DPT

  • Physical Therapist
  • Saint Paul, MN
National Provider Identifier
1396422622
Registry record updated Jun 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
13102 Issued in MN
Practice address
2270 Ford Pkwy Ste 200
Saint Paul, MN 55116-3412
Phone
(855) 324-7843
NPI assigned
Jun 28, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 29, 2023

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 13102 MN Primary

Addresses

Primary practice location

2270 Ford Pkwy Ste 200
Saint Paul, MN 55116-3412

Mailing address

700 Vikings Pkwy Unit 229
Eagan, MN 55121-1952
Phone (320) 310-3853

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230726000697 MN Practitioner - Physical Therapist in Private Practice 4183085061 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care Current Accepting new patients
Healtheast Outpatient Services, LLC Physical Therapist CurrentSince Jul 1, 2023 Accepting new patients
Fairview Express Care CurrentSince Jul 1, 2023 Accepting new patients
Fairview Express Care CurrentSince Jul 1, 2023 Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

15650 Cedar Ave
Ste 160
Apple Valley, MN 55124
Phone (952) 997-4170

1750 105th Ave NE
Blaine, MN 55449
Phone (763) 780-0356

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

6341 University Ave NE
Ste 104
Fridley, MN 55432
Phone (763) 572-4946

12000 Elm Creek Blvd N
Ste 120
Maple Grove, MN 55369
Phone (763) 420-9960

600 W 98th St
Ste 390
Minneapolis, MN 55420
Phone (952) 460-4900

10000 Zane Ave N
Minneapolis, MN 55443
Phone (763) 528-6999

3400 W 66th St
Ste 290
Minneapolis, MN 55435
Phone (952) 836-3637

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

9220 Bass Lake Rd
Ste 260
New Hope, MN 55428
Phone (763) 533-0363

2270 Ford Pkwy
Ste 200
Saint Paul, MN 55116
Phone (651) 696-5000

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

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

9680 Tamarack Rd
Ste 130
Woodbury, MN 55125
Phone (612) 273-1172

Organizations & group practices 6

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": "1687910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1396422622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 VIKINGS PKWY UNIT 229",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551211952",
            "telephone_number": "320-310-3853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2270 FORD PKWY STE 200",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551163412",
            "telephone_number": "855-324-7843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASIANOV",
        "first_name": "CARTER",
        "middle_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-28",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "13102",
            "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 Jun 29, 2023; 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.