Individual provider Active NPI

Amy Pearson, MA, PT, CWS

  • Physical Therapist
  • Park Falls, WI
National Provider Identifier
1801078084
Registry record updated Nov 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4700-024 Issued in WI
Practice address
98 Sherry Ave
Park Falls, WI 54552-1467
Phone
(715) 762-7470
Fax
(715) 762-3602
NPI assigned
Nov 29, 2007
Last updated
Nov 29, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 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 4700-024 WI Primary

Addresses

Primary practice location

98 Sherry Ave
Park Falls, WI 54552-1467

Mailing address

98 Sherry Ave
Park Falls, WI 54552-1467
Phone (715) 762-7470

Other identifiers 1

IdentifierTypeStateIssuer
40225800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200911001154 WI Practitioner - Physical Therapist in Private Practice 2860816014 Reassigns benefits to 1 organization
I20221223000115 MN Practitioner - Physical Therapist in Private Practice 2860816014 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

15301 Grove Cir N
Maple Grove, MN 55369-4475
Phone (952) 993-5900

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
4700-024WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Dec 12, 2022 Accepting new patients
Elite Therapy Institute LLC Physical Therapist CurrentSince May 11, 2020 Accepting new patients
Park Nicollet Clinic Current Accepting new patients
Park Nicollet Clinic CurrentSince Dec 12, 2022 Accepting new patients

Locations

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

1801 W Knapp St
Ste 4
Rice Lake, WI 54868
Phone (715) 736-4384

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/18208/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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": "1196294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196294400000",
    "number": "1801078084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 SHERRY AVE",
            "city": "PARK FALLS",
            "state": "WI",
            "postal_code": "545521467",
            "telephone_number": "715-762-7470",
            "fax_number": "715-762-3602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 SHERRY AVE",
            "city": "PARK FALLS",
            "state": "WI",
            "postal_code": "545521467",
            "telephone_number": "715-762-7470",
            "fax_number": "715-762-3602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARSON",
        "first_name": "AMY",
        "credential": "MA, PT, CWS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-29",
        "last_updated": "2007-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "4700-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40225800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Falls, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 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.