Individual provider Active NPI

Mark Thetford

  • Certified Registered Nurse Anesthetist
  • Fort Myers, FL
National Provider Identifier
1104335660
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
ARNP9397749 Issued in FL
Practice address
13681 Doctors Way
Fort Myers, FL 33912-4300
Phone
(239) 343-1000
NPI assigned
Sep 27, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN9397749 FL
Certified Registered Nurse Anesthetist 367500000X ARNP9397749 FL Primary

Addresses

Primary practice location

13681 Doctors Way
Fort Myers, FL 33912-4300

Mailing address

11131 Everblades Pkwy
Estero, FL 33928-9546
Phone (618) 889-8220

Other practice location 1

13681 Doctors Way
Fort Myers, FL 33912-4300
Phone (239) 343-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171221000477 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 9133487143 Reassigns benefits to 3 organizations
I20231120002355 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 9133487143 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Anesthesiology Services of Florida IncGroup PAC ID 1850674540, 159 clinicians
Northstar Anesthesia of Illinois, LLCGroup PAC ID 4688893878, 404 clinicians

Practice addresses (Care Compare)

13681 Doctors Way
Fort Myers, FL 33912-4300
Phone (239) 343-1000

201 S 14TH St
Herrin, IL 62948-3631
Phone (618) 942-2171

Hospital & facility affiliations

  • Gulf Coast Medical Center Lee Health Hospital, Fort Myers, FL, CCN 100220
  • Memorial Hospital of Carbondale Hospital, Carbondale, IL, CCN 140164

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN9397749FLMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology Services of Florida, Inc. CurrentSince May 1, 2024 Accepting new patients
Northstar Anesthesia of Illinois, LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 9, 2023 Accepting new patients
US Anesthesia Partners of Florida Inc. Nurse Anesthetist, Certified Registered CurrentSince Jan 21, 2019 Accepting new patients
Anesthesia & Pain Consultants of SW FL CurrentSince Nov 1, 2017 Accepting new patients
Outpatient Anesthesia of Southwest Florida Inc PastSince Jan 1, 2013 Accepting new patients

Locations

13500 Powers Ct
Ste 230
Fort Myers, FL 33912
Phone (239) 610-0784

2776 Cleveland Ave
Fort Myers, FL 33901
Phone (239) 343-2000

4035 Evans Ave
Fort Myers, FL 33901
Phone (941) 939-4937

13681 Doctors Way
Fort Myers, FL 33912
Phone (239) 343-1000

12511 World Plaza Ln
Bldg 50
Fort Myers, FL 33907
Phone 2399392622 ext. 300

4725 N Federal Hwy
Oakland Park, FL 33308
Phone (954) 493-5005

601 E Rollins St
Orlando, FL 32803
Phone (407) 303-1996

6901 Simmons Loop
Riverview, FL 33578
Phone (813) 302-8000

400 Health Park Blvd
St Augustine, FL 32086
Phone (904) 819-4300

1000 Waterman Way
Tavares, FL 32778
Phone (352) 253-3333

405 W Jackson St
Carbondale, IL 62901

201 S 14th St
Herrin, IL 62948
Phone (618) 942-2171

1423 Chicago Rd
Sauk Village, IL 60411
Phone (708) 679-2160

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

Organizations & group practices 5

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1506470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1104335660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11131 EVERBLADES PKWY",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339289546",
            "telephone_number": "618-889-8220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13681 DOCTORS WAY",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124300",
            "telephone_number": "239-343-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13681 Doctors Way",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339124300",
            "country_code": "US",
            "telephone_number": "239-343-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THETFORD",
        "first_name": "MARK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-27",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9397749",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "ARNP9397749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.