Individual provider Active NPI

Ben Wahlquist, DPT

  • Orthopedic Physical Therapist
  • Maple Grove, MN
National Provider Identifier
1861053944
Registry record updated Jun 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
11596 Issued in MN
Practice address
15301 Grove Cir N
Maple Grove, MN 55369-4475
Phone
(952) 993-5900
NPI assigned
Jun 27, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 11596 MN Primary

Addresses

Primary practice location

15301 Grove Cir N
Maple Grove, MN 55369-4475

Mailing address

15301 Grove Cir N
Maple Grove, MN 55369-4475

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Minnesota Luna Care Physical Therapy LLC Orthopedic CurrentSince Jun 26, 2023 Accepting new patients
Park Nicollet Clinic CurrentSince Jul 10, 2019 Accepting new patients
Park Nicollet Clinic CurrentSince Jul 10, 2019 Accepting new patients

Locations

15301 Grove Cir N
Maple Grove, MN 55369
Phone (952) 412-3463

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

428 Minnesota St
Ste 500
Saint Paul, MN 55101
Phone (612) 662-9604

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": "1561593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561852800000",
    "number": "1861053944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15301 GROVE CIR N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15301 GROVE CIR N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694475",
            "telephone_number": "952-993-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHLQUIST",
        "first_name": "BEN",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-27",
        "last_updated": "2019-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MN",
            "license": "11596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.