JACLYN GREVENGOED (PT) – Physical Therapist, NPI 1144650482
Physical Therapist
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Profile Insights
NPPES metrics only — not quality of care.
841 PHYSICAL THERAPIST IN PRIVATE PRACTICE in NE
Provider Addresses for JACLYN GREVENGOED (PT)
7505 COUNTRY CLUB DR
GOLDEN VALLEY, MN 554274501
Phone: (763) 450-6902
Type: Mailing
13616 CALIFORNIA ST STE 100
OMAHA, NE 681545336
Phone: (402) 496-0404
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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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: 2019-07-23
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20190723003126 | I | Physical Therapist In Private Practice | NE | TBD |
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.
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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 666 | 112 | $0 |
| 97530 | Therapy procedure using functional activities | 426 | 94 | $0 |
| 97163 | Evaluation for physical therapy, typically 45 minutes | 53 | 46 | $0 |
| 97162 | Evaluation for physical therapy, typically 30 minutes | 44 | 40 | $0 |
| 97164 | Re-evaluation for physical therapy, typically 20 minutes | 24 | 24 | $0 |
Insurance plans in this area (ZIP 55427)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICAL THERAPY | MN | 97001 | Physical therapy evaluation | 43 | 35 |
| PHYSICAL THERAPY | MN | 97110 | Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 537 | 45 |
| PHYSICAL THERAPY | MN | 97140 | Manual (physical) therapy techniques to 1 or more regions, each 15 minutes | 497 | 41 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Orthopedic Surgery | NE | |
| - | NE | |
| Nurse Practitioner | NE | |
| Physical Therapist In Private Practice | NE | |
| Physician Assistant | NE | |
| Physical Therapist In Private Practice | AZ | |
| Orthopedic Surgery | NE | |
| Physical Therapist In Private Practice | CA | |
| Orthopedic Surgery | NE | |
| Physician Assistant | NE |
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