Active NPI
Matthew Gram, OTR/L
- Physical Therapy Clinic/Center
- Saint Paul, MN
National Provider Identifier
1518627116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- License
- 106669
- Practice address
- 1600 University Ave W # 10
Saint Paul, MN 55104-3898 - Phone
- (651) 646-7246
- NPI assigned
- Dec 22, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | 106669 | MN | Primary |
Addresses
Primary practice location
1600 University Ave W # 10
Saint Paul, MN 55104-3898
Mailing address
1600 University Ave W # 10
Saint Paul, MN 55104-3898
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220414002235 | MN | Practitioner - Occupational Therapist in Private Practice | 5395131510 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 106669 | MN | MD | Physical Therapy Clinic/Center |
| 10669 | MN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1640131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640131200000",
"number": "1518627116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 UNIVERSITY AVE W # 10",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551043898"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 UNIVERSITY AVE W # 10",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551043898",
"telephone_number": "651-646-7246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAM",
"first_name": "MATTHEW",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-12-22",
"last_updated": "2021-12-22",
"certification_date": "2021-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "MN",
"license": "106669",
"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 Dec 22, 2021; 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.