Individual provider Active NPI

Janice Faye Gross, OT

  • Occupational Therapist
  • St Louis Park, MN
National Provider Identifier
1649413493
Registry record updated May 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
101776 Issued in MN
Practice address
5320 W 23Rd St
St Louis Park, MN 55416-1663
Phone
(952) 486-0293
NPI assigned
Apr 9, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2020

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 101776 MN Primary

Addresses

Primary practice location

5320 W 23Rd St
St Louis Park, MN 55416-1663

Mailing address

11821 Red Fox Dr
Maple Grove, MN 55369-6339
Phone (612) 760-6746

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
101776MNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Capernaum Pediatric Therapy, Inc. Past Accepting new patients
Lifespark Medical Group, PA PastSince May 24, 2020 Accepting new patients
Capernaum Pediatric Therapy, Inc. Past Accepting new patients

Organizations & group practices 3

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": "1239235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589932800000",
    "number": "1649413493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11821 RED FOX DR",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553696339",
            "telephone_number": "612-760-6746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5320 W 23RD ST",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161663",
            "telephone_number": "952-486-0293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSS",
        "first_name": "JANICE",
        "middle_name": "FAYE",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-09",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "101776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.