Individual provider Active NPI

Justin Adam Kertis, DPT

  • Physical Therapist
  • Eagan, MN
National Provider Identifier
1891470167
Registry record updated Jun 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
2620 Eagan Woods Dr Ste 100
Eagan, MN 55121-1138
Phone
(651) 968-5201
Fax
(651) 968-5903
NPI assigned
Jun 15, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2023

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 MN Primary

Addresses

Primary practice location

2620 Eagan Woods Dr Ste 100
Eagan, MN 55121-1138

Mailing address

710 Commerce Dr Ste 200
Woodbury, MN 55125-4925

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230717001360 MN Practitioner - Physical Therapist in Private Practice 7618337064 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Orthopedics, LTDGroup PAC ID 8921900374, 282 clinicians

Practice addresses (Care Compare)

2620 Eagan Woods Dr
Eagan, MN 55121-1138
Phone (651) 968-5201

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Orthopedics, LTD Current Accepting new patients
Summit Orthopedics, LTD. CurrentSince Jul 24, 2023 Accepting new patients
Summit Orthopedics LTD CurrentSince Jul 24, 2023 Accepting new patients

Locations

2620 Eagan Woods Dr
Ste 100
Eagan, MN 55121
Phone (651) 968-5230

1661 Saint Anthony Ave
Saint Paul, MN 55104
Phone (651) 968-5300

2620 Eagan Woods Dr
Saint Paul, MN 55121
Phone (651) 968-5142

710 Commerce Dr
Ste 200
Woodbury, MN 55125
Phone (651) 968-5042

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": "1686787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1891470167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 COMMERCE DR STE 200",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 EAGAN WOODS DR STE 100",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551211138",
            "telephone_number": "651-968-5201",
            "fax_number": "651-968-5903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERTIS",
        "first_name": "JUSTIN",
        "middle_name": "ADAM",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-15",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; 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.