Individual provider Active NPI

Rebecca Susan Dockter, PT

  • Physical Therapist
  • Breckenridge, MN
National Provider Identifier
1902009491
Registry record updated Jun 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1245 Issued in ND
Practice address
430 5TH St N
Breckenridge, MN 56520-1426
Phone
(218) 641-7725
Fax
(218) 641-6625
NPI assigned
Jun 11, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2012

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 1245 ND 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 1

IdentifierTypeStateIssuer
55104MedicaidND

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120831000274 MN Practitioner - Physical Therapist in Private Practice 4082709357 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic and Sports Physical Therapy, IncGroup PAC ID 7416901921, 6 clinicians

Practice addresses (Care Compare)

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1245NDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic & Sports Physical Therapy, Inc. CurrentSince May 30, 2012 Accepting new patients
Orthopedic & Sports Physical Therapy, Inc Physical Therapist CurrentSince May 30, 2012 Accepting new patients

Locations

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

73 Minnesota Ave
Breckenridge, MN 56520
Phone (218) 641-7725

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

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339977600000",
    "number": "1902009491",
    "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": {
        "last_name": "DOCKTER",
        "first_name": "REBECCA",
        "middle_name": "SUSAN",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-11",
        "last_updated": "2012-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ND",
            "license": "1245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55104",
            "state": "ND"
        }
    ],
    "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 Jun 18, 2012; 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.