Active NPI
Jason Kelecic
- Physical Therapist
- Bloomington, MN
National Provider Identifier
1801587282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 7064
- Practice address
- 8100 Highwood Dr
Bloomington, MN 55438-1006 - Phone
- (952) 831-7500
- NPI assigned
- May 17, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 7064 | MN | Primary |
Addresses
Primary practice location
8100 Highwood Dr
Bloomington, MN 55438-1006
Mailing address
1281 Gorman Ave
West St Paul, MN 55118-2429
Phone (952) 240-4014
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7064 | MN | MD | Neonatal Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684281600000",
"number": "1801587282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1281 GORMAN AVE",
"city": "WEST ST PAUL",
"state": "MN",
"postal_code": "551182429",
"telephone_number": "952-240-4014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8100 HIGHWOOD DR",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554381006",
"telephone_number": "952-831-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELECIC",
"first_name": "JASON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-17",
"last_updated": "2023-05-17",
"certification_date": "2023-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "7064",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.