Individual provider Active NPI

Chad Matthew Clemensen, PT

  • Physical Therapist
  • Minneapolis, MN
National Provider Identifier
1568479657
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5493 Issued in MN
Practice address
650 Taft St NE
#400
Minneapolis, MN 55413-2832
Phone
(612) 331-1815
NPI assigned
Aug 1, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 5493 MN Primary

Addresses

Primary practice location

650 Taft St NE
#400
Minneapolis, MN 55413-2832

Mailing address

11128 Rhode Island Ave S
Bloomington, MN 55438-2470

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060227000197 MN Practitioner - Physical Therapist in Private Practice 2163438318 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1994
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)

1700 University Ave W
Saint Paul, MN 55104-3727
Phone (855) 324-7843

18580 Joplin Ave
Lakeville, MN 55044-4218
Phone (952) 892-9555

18592 Joplin Ave
Lakeville, MN 55044-4218
Phone (952) 892-9551

717 Delaware St SE
Suite 340
Minneapolis, MN 55414-2959
Phone (612) 672-7422

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 Health Services Current Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Express Care CurrentSince Mar 1, 2020 Accepting new patients
Fairview Express Care CurrentSince Sep 7, 2018 Accepting new patients
Fairview Health Services CurrentSince Sep 7, 2018 Accepting new patients
Fairview Express Care CurrentSince Mar 1, 2020 Accepting new patients

Locations

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

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

400 Stinson Blvd
Fl 2
Minneapolis, MN 55413
Phone (612) 672-2203

650 Taft St NE
Ste 400
Minneapolis, MN 55413
Phone (612) 331-1815

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

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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1568479657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11128 RHODE ISLAND AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554382470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 TAFT ST NE",
            "address_2": "#400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554132832",
            "telephone_number": "612-331-1815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMENSEN",
        "first_name": "CHAD",
        "middle_name": "MATTHEW",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "5493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.