NPIMap

Organization Active NPI

Optimum Therapies of North Dakota, Inc

  • Physical Therapy Clinic/Center
  • Bismarck, ND
National Provider Identifier
1679010953
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
2031 Issued in ND
Legal business name
OPTIMUM THERAPIES OF NORTH DAKOTA, INC
Practice address
1040 Canada Ave Ste 1
Bismarck, ND 58503-1813
Phone
(751) 751-3064
Fax
(701) 751-2265
NPI assigned
Jan 25, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

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

Authorized official

Name
Collin Kudrna, DPT, OCSNPI 1225397664
Title
President
Phone
(701) 590-0316

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
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 2031 ND
Physical Therapy Clinic/Center 261QP2000X 2031 ND Primary

Addresses

Primary practice location

1040 Canada Ave Ste 1
Bismarck, ND 58503-1813

Mailing address

1040 Canada Ave Ste 1
Bismarck, ND 58503-1813
Phone (715) 855-0430

Other practice location 1

4524 Memorial Hwy Unit 107
Mandan, ND 58554-4771
Phone (701) 751-3064

Other identifiers 1

IdentifierTypeStateIssuer
2031OtherNDNORTH DAKOTA BOARD OF PHYSICAL THERAPY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170518001424 ND Part B Supplier - Clinic/Group Practice 8628345840 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
Practice locations: Bismarck, ND; Mandan, ND

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Optimum Therapies of North Dakota Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1040 Canada Ave
Bismarck, ND 58503

4204 Boulder Ridge Rd
Ste 100
Bismarck, ND 58503
Phone (701) 590-0316

4524 Memorial Hwy
Unit 107
Mandan, ND 58554
Phone (701) 751-3064

4254 Memorial Hwy Unit 107
Mandan, ND 58554

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 11

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": "1485302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734480000000",
    "number": "1679010953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 CANADA AVE STE 1",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585031813",
            "telephone_number": "715-855-0430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 CANADA AVE STE 1",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585031813",
            "telephone_number": "751-751-3064",
            "fax_number": "701-751-2265"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4524 Memorial Hwy Unit 107",
            "address_purpose": "LOCATION",
            "city": "Mandan",
            "state": "ND",
            "postal_code": "585544771",
            "country_code": "US",
            "telephone_number": "701-751-3064",
            "fax_number": "701-751-2265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPTIMUM THERAPIES OF NORTH DAKOTA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-25",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A",
        "authorized_official_last_name": "KUDRNA",
        "authorized_official_first_name": "COLLIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-590-0316",
        "authorized_official_credential": "DPT, OCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "ND",
            "license": "2031",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "ND",
            "license": "2031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH DAKOTA BOARD OF PHYSICAL THERAPY",
            "identifier": "2031",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bismarck, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; 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.