Mark K Thalacker, CNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

R096321-5 Issued in MN

Practice address

1875 Woodwinds Dr
Suite 130
Woodbury, MN 55125-2298

Phone

(651) 232-0500

NPI assigned

Feb 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

92.68 of 100Reported as group

Quality

89.73

Promoting interoperability

100

Improvement activities

40

Cost

80.99

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

Practice roles

Locations

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.

• Healtheast Medical Research Institute

  dba HealthEast Vadnais Heights Clinic

  • Clinic/Center
  • Vadnais Heights, MN
  • NPI 1639125503
  Medicare reassignment NPD
• Healtheast Medical Research Institute

  dba HealthEast Professional Services

  • Internal Medicine Physician
  • Saint Paul, MN
  • NPI 1508191552
  NPD
• Healtheast Medical Research Institute

  dba HealthEast Surgery

  • Surgery Physician
  • Maplewood, MN
  • NPI 1750791810
  NPD

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1063483493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 WOODWINDS DR",
            "address_2": "SUITE 130",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252298",
            "telephone_number": "651-232-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 WOODWINDS DR",
            "address_2": "SUITE 130",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252298",
            "telephone_number": "651-232-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THALACKER",
        "first_name": "MARK",
        "middle_name": "K",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-01",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "R096321-5",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "815725100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.