NICHOLAS CHAMBERLAIN (DPT) – Physical Therapist, NPI 1114791977

NICHOLAS CHAMBERLAIN (DPT) is a healthcare provider. based in Lake city, Minnesota. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials DPT. They hold a License No. 12749 (MN). The NPI Number for NICHOLAS CHAMBERLAIN (DPT) is 1114791977

Main info

Male
4 Years Of Experience
Accepts Medicare Assignment
Name
NICHOLAS CHAMBERLAIN (DPT)
NPI
1114791977
Phone
(651) 345-2350
Address
507 W DOUGHTY ST
Enumeration Date
13 November 2023
Last Update Date
13 November 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5072883443
Graduation Year
2022 (4 years ago)
PAC ID
3375987423
Group Practice PAC ID
8527970060
Professional Enrollment ID
I20240216003518
Address ID
MN559046425RO210XXSEXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:2State licenses:1Digital endpointsOther names

2,108 PHYSICAL THERAPIST IN PRIVATE PRACTICE in MN

Provider Addresses for NICHOLAS CHAMBERLAIN (DPT)

  • 507 W DOUGHTY ST

    LAKE CITY, MN 550411500

    Phone: (651) 345-2350

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-02-16

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240216003518IPhysical Therapist In Private PracticeMNTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55041)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8527970060View full group profile
NameSpecialtyState
Emergency MedicineMN
Nurse PractitionerMN
Family PracticeMN
Family PracticeMN
Family PracticeMN
O B S T E T R I C S/ G Y N E C O L O G YMN
O B S T E T R I C S/ G Y N E C O L O G YMN
Certified Registered Nurse Anesthetist (Crna)MN
P A T H O L O G YMN
D E R M A T O L O G YTN

Reviews

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Frequently asked questions

How is NICHOLAS CHAMBERLAIN (DPT) identified in CMS data?
CMS-hosted NPPES data lists NICHOLAS CHAMBERLAIN (DPT) with NPI 1114791977.
Can I rely on NICHOLAS CHAMBERLAIN (DPT) being an active provider?
As of the registry snapshot, NICHOLAS CHAMBERLAIN (DPT) is marked active.
What taxonomy line describes NICHOLAS CHAMBERLAIN (DPT)?
For research purposes, treat NICHOLAS CHAMBERLAIN (DPT) as Physical Therapist in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for NICHOLAS CHAMBERLAIN (DPT)?
NICHOLAS CHAMBERLAIN (DPT)'s geographic hint is Lake City, Minnesota in our summary view.
Is the information about NICHOLAS CHAMBERLAIN (DPT) up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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