Individual provider Active NPI

Mary Jean Thielman, APRN

  • Nurse Practitioner
  • Hartford, CT
National Provider Identifier
1215962139
Registry record updated Oct 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
000925 Issued in CT
Practice address
80 Seymour Street
Hartford Hospital Surgery Dept
Hartford, CT 06102-5037
Phone
(860) 545-2840
NPI assigned
Jul 11, 2006
Last updated
Oct 2, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 000925 CT Primary

Addresses

Primary practice location

80 Seymour Street
Hartford Hospital Surgery Dept
Hartford, CT 06102-5037

Mailing address

PO Box 40,000 Dept 634
Hartford Hospital Professional Services
Hartford, CT 06151-0634
Phone (860) 545-7602

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidCT

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

State licenses

LicenseStateTypeSpecialty
925CTMDBehavioral Analyst
000925CTMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Allan S Kratzer MD PC Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254441600000",
    "number": "1215962139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40,000 DEPT 634",
            "address_2": "HARTFORD HOSPITAL PROFESSIONAL SERVICES",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061510634",
            "telephone_number": "860-545-7602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 SEYMOUR STREET",
            "address_2": "HARTFORD HOSPITAL SURGERY DEPT",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061025037",
            "telephone_number": "860-545-2840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIELMAN",
        "first_name": "MARY",
        "middle_name": "JEAN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2009-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "000925",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2009; 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.