Individual provider Active NPI

Autumne Haskell, PT, DPT

  • Physical Therapist
  • Bismarck, ND
National Provider Identifier
1881433480
Registry record updated Feb 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
307068 Issued in CA
Practice address
2625 N 19TH St
Bismarck, ND 58503-0574
Phone
(701) 222-3175
Fax
(701) 222-3186
NPI assigned
May 22, 2024
Last updated
Feb 5, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2671 ND
Physical Therapist 225100000X 307068 CA Primary

Addresses

Primary practice location

2625 N 19TH St
Bismarck, ND 58503-0574

Mailing address

300 N 7TH St
Bismarck, ND 58501-4439

Other practice location 1

300 N 7th St
Bismarck, ND 58501-4439
Phone (701) 323-6150

Other identifiers 1

IdentifierTypeStateIssuer
1492495MedicaidND

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250417001997 CA Practitioner - Physical Therapist in Private Practice 3274058623 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
California Luna Care Physical Therapy PCGroup PAC ID 9638427834, 769 clinicians

Practice addresses (Care Compare)

16185 Los Gatos Blvd
Suite 205
Los Gatos, CA 95032-4569
Phone (866) 525-3175

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2671NDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Red Door Pediatric Therapy, Inc Physical Therapist CurrentSince Jun 9, 2024 Accepting new patients
California Luna Care Physical Therapy PC Physical Therapist CurrentSince Oct 31, 2025 Accepting new patients

Locations

16185 Los Gatos Blvd
Ste 205
Los Gatos, CA 95032
Phone (408) 409-4167

Organizations & group practices 2

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": "1716336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1881433480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 N 7TH ST",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 N 19TH ST",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585030574",
            "telephone_number": "701-222-3175",
            "fax_number": "701-222-3186"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 N 7th St",
            "address_purpose": "LOCATION",
            "city": "Bismarck",
            "state": "ND",
            "postal_code": "585014439",
            "country_code": "US",
            "telephone_number": "701-323-6150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HASKELL",
        "first_name": "AUTUMNE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-22",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ND",
            "license": "2671",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "307068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1492495",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bismarck, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; 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.