Individual provider Active NPI

Kayla Marie Tackmann, DPT

  • Physical Therapist
  • Saint Paul, MN
National Provider Identifier
1700369790
Registry record updated Apr 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11127 Issued in MN
Practice address
30 Fairview Ave S Ste 200
Saint Paul, MN 55105-1463
Phone
(952) 835-4512
Fax
(888) 425-0398
NPI assigned
Sep 14, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2023

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 11127 MN Primary

Addresses

Primary practice location

30 Fairview Ave S Ste 200
Saint Paul, MN 55105-1463

Mailing address

7825 3Rd St N Ste 105
Oakdale, MN 55128-5403
Phone (952) 835-4512

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181004002070 MN Practitioner - Physical Therapist in Private Practice 5597017467 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Mayo Medical School, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infinite Health Collaborative, PAGroup PAC ID 1052225042, 815 clinicians

Practice addresses (Care Compare)

1686 Lexington Ave N
Roseville, MN 55113-6514
Phone (877) 609-0123

Merit-based Incentive Payment System (MIPS)

Final score
91.79 of 100Reported as group
Quality
95.08
Improvement activities
40
Cost
81.67

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA Physical Therapist CurrentSince Jan 1, 2023 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Jan 1, 2023 Accepting new patients
St. Croix Orthopaedics, PA Past Accepting new patients

Locations

6520 150th St W
Ste 100
Apple Valley, MN 55124

2665 W 78th St
Chanhassen, MN 55317
Phone (612) 834-1664

3365 Central Park Village Dr
#100
Eagan, MN 55121

4200 Dahlberg Dr
Ste 300
Minneapolis, MN 55422
Phone (952) 512-5600

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

1686 Lexington Ave N
Roseville, MN 55113

30 Fairview Ave S
#200
Saint Paul, MN 55105

3912 Excelsior Blvd
St Louis Park, MN 55416
Phone (528) 354-5129

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": "1536883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681084800000",
    "number": "1700369790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7825 3RD ST N STE 105",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551285403",
            "telephone_number": "952-835-4512",
            "fax_number": "888-425-0398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 FAIRVIEW AVE S STE 200",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551051463",
            "telephone_number": "952-835-4512",
            "fax_number": "888-425-0398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKMANN",
        "first_name": "KAYLA",
        "middle_name": "MARIE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-14",
        "last_updated": "2023-04-10",
        "certification_date": "2023-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "11127",
            "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 Apr 10, 2023; 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.