Individual provider Active NPI

Amy Mueller, OTR/L

  • Occupational Therapist
  • Fargo, ND
National Provider Identifier
1437445327
Registry record updated Oct 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
955 Issued in ND
Practice address
1702 University Dr S
Fargo, ND 58103-4940
Phone
(701) 364-3300
Fax
(701) 364-8906
NPI assigned
Jun 20, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2011

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 955 ND Primary

Addresses

Primary practice location

1702 University Dr S
Fargo, ND 58103-4940

Mailing address

PO Box 6001
Fargo, ND 58108-6001
Phone (701) 364-3300

Other identifiers 2

IdentifierTypeStateIssuer
1437445327MedicaidMN
55839MedicaidND

Other names 1

  • Amy Gustafson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, ND2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110726000060 MN Practitioner - Occupational Therapist in Private Practice 8729256359 Reassigns benefits to 1 organization
I20110802000504 ND Practitioner - Occupational Therapist in Private Practice 8729256359 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Innovis Health LLCGroup PAC ID 9931298155, shared by 7 NPIs, 561 clinicians

Practice addresses (Care Compare)

3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000

801 Belsly Blvd
Moorhead, MN 56560-5055
Phone (701) 364-6800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
955NDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Innovis Health, LLC. CurrentSince Jul 11, 2011 Accepting new patients
Innovis Health LLC Current Accepting new patients
Innovis Health LLC CurrentSince Jul 11, 2011 Accepting new patients
Innovis Health, LLC CurrentSince Jul 11, 2011 Accepting new patients

Locations

801 Belsly Blvd
Moorhead, MN 56560
Phone (218) 364-6800

208 Oppegard Ave NW
Twin Valley, MN 56584
Phone (218) 584-5181

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000

1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222

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": "1308528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319673600000",
    "number": "1437445327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6001",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581086001",
            "telephone_number": "701-364-3300",
            "fax_number": "701-364-8906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940",
            "telephone_number": "701-364-3300",
            "fax_number": "701-364-8906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUELLER",
        "first_name": "AMY",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-20",
        "last_updated": "2011-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ND",
            "license": "955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1437445327",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55839",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "GUSTAFSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; 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.