NPIMap

Organization Active NPI

Prairie Grit Adaptive Sports

  • Clinic/Center
  • Minot, ND
National Provider Identifier
1417577693
Registry record updated Apr 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PRAIRIE GRIT ADAPTIVE SPORTS
Practice address
3515 16TH St SW
Minot, ND 58701-7225
Phone
(208) 949-3315
NPI assigned
Apr 17, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2020

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

Authorized official

Name
Krystal Rene' Butgereit, MOT, OTR/LNPI 1295172997
Title
Executive Director
Phone
(208) 949-3315

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

3515 16TH St SW
Minot, ND 58701-7225

Mailing address

PO Box 969
Minot, ND 58702-0969
Phone (208) 949-3315

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260112002854 ND Part B Supplier - Clinic/Group Practice 3870079502 Receives reassigned benefits from 3 practitioners
Practice locations: Minot, ND

National Provider Directory

National Provider Directory

Locations

3515 16th St SW
Minot, ND 58701
Phone (701) 838-1080

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587081600000",
    "number": "1417577693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 969",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587020969",
            "telephone_number": "208-949-3315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3515 16TH ST SW",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587017225",
            "telephone_number": "208-949-3315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE GRIT ADAPTIVE SPORTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-17",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A",
        "authorized_official_last_name": "BUTGEREIT",
        "authorized_official_first_name": "KRYSTAL",
        "authorized_official_middle_name": "RENE'",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "208-949-3315",
        "authorized_official_credential": "MOT, OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minot, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; 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.