NPIMap

Organization Active NPI

Orthopedic & Sports Physical Therapy, Inc.

  • Multi-Specialty Clinic/Center
  • Fergus Falls, MN
National Provider Identifier
1992224331
Registry record updated Dec 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
ORTHOPEDIC & SPORTS PHYSICAL THERAPY, INC.
Practice address
322 N Tower Rd
Fergus Falls, MN 56537-1015
Phone
(218) 998-2980
Fax
(218) 998-2981
NPI assigned
Sep 18, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2017

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

Authorized official

Name
Shawn Krause-Roberts, PT, MPT, ATCNPI 1861449019
Title
PT, President, Ceo
Phone
(218) 641-7725

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

322 N Tower Rd
Fergus Falls, MN 56537-1015

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050308000871 MN Part B Supplier - Clinic/Group Practice 7416901921 Receives reassigned benefits from 13 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Breckenridge, MN; Fergus Falls, MN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Orthopedic and Sports Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

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

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

322 N Tower Rd
Fergus Falls, MN 56537
Phone (218) 371-2843

5475 51st Ave S
#A
Fargo, ND 58104
Phone (701) 532-1655

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1505692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512432000000",
    "number": "1992224331",
    "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": "322 N TOWER RD",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565371015",
            "telephone_number": "218-998-2980",
            "fax_number": "218-998-2981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC & SPORTS PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-18",
        "last_updated": "2017-12-05",
        "status": "A",
        "authorized_official_last_name": "KRAUSE-ROBERTS",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "PT, PRESIDENT, CEO",
        "authorized_official_telephone_number": "218-641-7725",
        "authorized_official_credential": "PT, MPT, ATC"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fergus Falls, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.