Individual provider Active NPI

Mark S Thomas, MD

  • Family Medicine Physician
  • Saint Paul, MN
National Provider Identifier
1093775686
Registry record updated Sep 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35858 Issued in MN
Practice address
153 Cesar Chavez St
Saint Paul, MN 55107-2226
Phone
(651) 602-7500
Fax
(651) 602-7580
NPI assigned
Mar 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35858 MN Primary

Addresses

Primary practice location

153 Cesar Chavez St
Saint Paul, MN 55107-2226

Mailing address

153 Cesar Chavez St
Saint Paul, MN 55107-2226
Phone (651) 602-7500

Other practice location 1

600 Pemberton Browns-Mills Rd.
Pemberton, NJ 08068-0248
Phone (609) 894-1100

Other identifiers 7

IdentifierTypeStateIssuer
HP17266OtherMNHEALTH PARTNERS
923877800MedicaidMN
01-16933OtherMNMEDICA
105424OtherMNUCARE
NA9021019261OtherMNPREFERRED ONE
2F800THOtherMNBCBS
0553794MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
West Side Community Health Services, Inc. Current Accepting new patients

Locations

153 Cesar Chavez St
West Saint Paul, MN 55107
Phone (651) 222-1816

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537315200000",
    "number": "1093775686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 CESAR CHAVEZ ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551072226",
            "telephone_number": "651-602-7500",
            "fax_number": "651-602-7580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 CESAR CHAVEZ ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551072226",
            "telephone_number": "651-602-7500",
            "fax_number": "651-602-7580"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Pemberton Browns-Mills Rd.",
            "address_purpose": "LOCATION",
            "city": "Pemberton",
            "state": "NJ",
            "postal_code": "080680248",
            "country_code": "US",
            "telephone_number": "609-894-1100",
            "fax_number": "609-894-1110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "MARK",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-27",
        "last_updated": "2018-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "35858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP17266",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "923877800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "01-16933",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "105424",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "NA9021019261",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2F800TH",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0553794",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.