NPIMap

Organization Active NPI

Orthopedic & Sports Physical Therapy, Inc

  • Multi-Specialty Clinic/Center
  • Breckenridge, MN
National Provider Identifier
1811923535
Registry record updated Jan 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
ORTHOPEDIC & SPORTS PHYSICAL THERAPY, INC
Practice address
430 5TH St N
Breckenridge, MN 56520-1426
Phone
(218) 641-7725
Fax
(218) 641-6625
NPI assigned
Jun 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2018

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

Authorized official

Name
Mrs. Shawn Marie Krause Roberts, PT/ATCNPI 1861449019
Title
President
Phone
(218) 641-7725

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 6521 MN
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 1180 ND
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

430 5TH St N
Breckenridge, MN 56520-1426

Mailing address

430 5TH St N
Breckenridge, MN 56520-1426
Phone (218) 641-7725

Other identifiers 8

IdentifierTypeStateIssuer
121G4OROtherMNMN BCBS FOR OT'S
148478000MedicaidMN
DD3739OtherMNRR MEDICARE
96570OtherMNHEALTH PARTNERS
1458152MedicaidND
057K80ROtherMNMN BCBS
101592300OtherMNUS DEPT OF LABOR
1041486OtherMNPREFERRED ONE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050308000871 MN Part B Supplier - Clinic/Group Practice 7416901921 Receives reassigned benefits from 13 practitioners
1 other NPI on this enrollment
Practice locations: Breckenridge, MN; Fergus Falls, MN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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

Locations

2450 College Way
Fergus Falls, MN 56537
Phone (218) 998-2980

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515542400000",
    "number": "1811923535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 5TH ST N",
            "city": "BRECKENRIDGE",
            "state": "MN",
            "postal_code": "565201426",
            "telephone_number": "218-641-7725",
            "fax_number": "218-641-6625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 5TH ST N",
            "city": "BRECKENRIDGE",
            "state": "MN",
            "postal_code": "565201426",
            "telephone_number": "218-641-7725",
            "fax_number": "218-641-6625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC & SPORTS PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2018-01-10",
        "status": "A",
        "authorized_official_last_name": "KRAUSE ROBERTS",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-641-7725",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT/ATC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "6521",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "ND",
            "license": "1180",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BCBS FOR OT'S",
            "identifier": "121G4OR",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "148478000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DD3739",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "96570",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1458152",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BCBS",
            "identifier": "057K80R",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "101592300",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1041486",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Breckenridge, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2018; 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.