Active NPI
Nels Marcus Thygeson, M.D.
- Gastroenterology Physician
- San Rafael, CA
National Provider Identifier
1114189495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- G54492
- Practice address
- 24 Mooring Rd
San Rafael, CA 94901-3515 - Phone
- (651) 269-1404
- NPI assigned
- Jun 27, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 47465 | MN | |
| Gastroenterology Physician | 207RG0100X | G54492 | CA | Primary |
Addresses
Primary practice location
24 Mooring Rd
San Rafael, CA 94901-3515
Mailing address
24 Mooring Rd
San Rafael, CA 94901-3515
Phone (651) 269-1404
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G54492 | CA | MD | Gastroenterology Physician |
| 47465 | MN | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464652800000",
"number": "1114189495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 MOORING RD",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949013515",
"telephone_number": "651-269-1404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 MOORING RD",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949013515",
"telephone_number": "651-269-1404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THYGESON",
"first_name": "NELS",
"middle_name": "MARCUS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-27",
"last_updated": "2016-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "MN",
"license": "47465",
"primary": false
},
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "CA",
"license": "G54492",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.