Individual provider Active NPI

Krystle Desiree Plohocky, MA, OTR/L

  • Occupational Therapist
  • Brooklyn Park, MN
National Provider Identifier
1902641798
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
103819 Issued in MN
Practice address
9751 Regent Ave N
Brooklyn Park, MN 55443-1402
Phone
(763) 315-5340
NPI assigned
Jun 25, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 103819 MN Primary

Addresses

Primary practice location

9751 Regent Ave N
Brooklyn Park, MN 55443-1402

Mailing address

1660 Highway 100 S Ste 103
Saint Louis Park, MN 55416-1599
Phone (763) 531-5039

Other practice location 1

7555 Bailey Rd
Woodbury, MN 55129-9610
Phone (651) 209-9170

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240904001243 MN Practitioner - Occupational Therapist in Private Practice 1456891563 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascend Rehab LLCGroup PAC ID 9032351192, 18 clinicians

Practice addresses (Care Compare)

Saint Louis Park, MN 55416
Phone (952) 283-2206

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

Practice roles

OrganizationSpecialtyStatusNew patients
Ascend Rehab, LLC CurrentSince Aug 1, 2024 Accepting new patients
Saint Therese of Oxbow Lake, LLC PastSince Jun 30, 2024 Accepting new patients

Locations

1660 Highway 100 S
Ste 103
St Louis Park, MN 55416
Phone (952) 283-2206

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": "1719273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1902641798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 HIGHWAY 100 S STE 103",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554161599",
            "telephone_number": "763-531-5039",
            "fax_number": "763-531-5004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9751 REGENT AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554431402",
            "telephone_number": "763-315-5340"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7555 Bailey Rd",
            "address_purpose": "LOCATION",
            "city": "Woodbury",
            "state": "MN",
            "postal_code": "551299610",
            "country_code": "US",
            "telephone_number": "651-209-9170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PLOHOCKY",
        "first_name": "KRYSTLE",
        "middle_name": "DESIREE",
        "credential": "MA, OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-25",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "103819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; 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.