Individual provider Active NPI

Jenna Brandt, DPT

  • Physical Therapist
  • Eagan, MN
National Provider Identifier
1679977607
Registry record updated Nov 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
9626 Issued in MN
Practice address
1440 Duckwood Dr
Eagan, MN 55122-1451
Phone
(651) 406-8989
NPI assigned
Oct 20, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2016

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 9626 MN Primary

Addresses

Primary practice location

1440 Duckwood Dr
Eagan, MN 55122-1451

Mailing address

2450 Riverside Ave
Minneapolis, MN 55454-1450

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160407000514 MN Practitioner - Physical Therapist in Private Practice 7214235217 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
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)

3305 Central Park Village Dr
Eagan, MN 55121-7707

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

State licenses

LicenseStateTypeSpecialty
9626MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care Current Accepting new patients
Fairview Express Care CurrentSince Feb 8, 2016 Accepting new patients
Fairview Express Care CurrentSince Mar 1, 2020 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Express Care CurrentSince Mar 1, 2020 Accepting new patients
Fairview Health Services CurrentSince Feb 8, 2016 Accepting new patients

Locations

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

1750 105th Ave NE
Blaine, MN 55449
Phone (763) 780-0356

3305 Central Park Village Dr
Ste 130
Eagan, MN 55121
Phone (651) 406-8701

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

6545 France Ave S
Ste 450A
Edina, MN 55435
Phone (952) 920-8525

6341 University Ave NE
Ste 104
Fridley, MN 55432
Phone (763) 572-4946

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

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

10000 Zane Ave N
Minneapolis, MN 55443
Phone (763) 528-6999

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

600 W 98th St
Ste 390
Minneapolis, MN 55420
Phone (952) 460-4900

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478649600000",
    "number": "1679977607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 DUCKWOOD DR",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551221451",
            "telephone_number": "651-406-8989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDT",
        "first_name": "JENNA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-20",
        "last_updated": "2016-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "9626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; 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.