JACK DAVID ANDERSON
NPI 1023712882
Marriage & Family Therapist in Maple Grove, MN
About Jack David Anderson NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACK DAVID ANDERSON (NPI 1023712882) is an individual marriage & family therapist in Maple Grove, Minnesota and active in the NPI registry since March 2023. He is enrolled in Medicare PECOS and is a graduate of Other (2023).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jack David Anderson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Jack Anderson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Coon Rapids, MN 55433
- Reassigned Medicare billing, Minnesota enrollment
- 22 clinicians in this Medicare group
Miami, FL 33130
- Reassigned Medicare billing, Minnesota enrollment
- 276 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
MAPLE GROVE, MN 55369
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jack Anderson's NPI number?
The NPI number for Jack Anderson is 1023712882. It was assigned to this individual provider in the NPPES registry on March 27, 2023.
Where is Jack Anderson located?
Jack Anderson practices at 10900 89th Ave N Ste 3, Maple Grove, MN 55369. The listed phone number is (651) 560-0050.
What is Jack Anderson's specialty?
The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.
Is Jack Anderson enrolled in Medicare?
Yes. Jack Anderson is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Jack Anderson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jack Anderson reassigns Medicare benefits to 2 organizations: Family Based Therapy Associates (Coon Rapids, MN) and Grow Healthcare Group PA (Miami, FL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jack Anderson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Jack Anderson accept?
Health plans from HealthPartners list Jack Anderson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Jack Anderson was last updated on March 27, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jack David Anderson · NPI 1023712882
Marriage & Family Therapist provider in Maple Grove, Minnesota. Individual provider, active in the CMS NPPES registry since March 27, 2023.
## Identity
- **NPI:** 1023712882 (Entity type: Individual)
- **Enumerated:** March 27, 2023
- **Primary specialty:** Marriage & Family Therapist · taxonomy 106H00000X
- **Sole proprietor:** No
## Practice location
- **Address:** 10900 89TH AVE N STE 3, Maple Grove, MN 55369-4025
- **Phone:** (651) 560-0050
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Family Based Therapy Associates (NPI 1194762005, Coon Rapids, MN); Grow Healthcare Group PA (NPI 1245845932, Miami, FL) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2023
## Record status
- **NPPES last updated:** March 27, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1023712882) · Data from the CMS NPPES public registry.