Dominic Thielen
Individual provider Active NPI Physical Therapist · Jefferson, IA
NPI 1316397144 · NPPES record last updated Dec 16, 2021
Key facts
- NPI
- 1316397144
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 083240 (IA)
- Practice address
- 106 W Washington St Ste 2
Jefferson, IA 50129-1920 - Phone
- (515) 386-4192
- NPI assigned
- Jun 13, 2016
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 10
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Des Moines University of Osteopathic Medicine and Health Sciences, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- McFarland Clinic PC
Practice addresses (Care Compare)
106 W Washington St
Suite 102
Jefferson, IA 50129-1920
Phone (515) 386-4192
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211124001478 | IA | Practitioner - Physical Therapist in Private Practice | 8921498486 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-4458 | ID | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McFarland Clinic PC | Current |
Accepting new patients | |
| McFarland Clinic, PC | Past | Accepting new patients |
Locations
3500 University Blvd
Ames, IA 50010
Phone (515) 239-3040
1215 Duff Ave
Ames, IA 50010
Phone (515) 239-4400
106 W Washington St
Ste 102
Jefferson, IA 50129
Phone (515) 386-4192
106 W Washington St
Ste 2
Jefferson, IA 50129
Phone (515) 386-4192
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT-4458 | ID | |
| Physical Therapist | 225100000X | 083240 | IA | Yes |
Addresses
Primary practice location
106 W Washington St Ste 2
Jefferson, IA 50129-1920
Mailing address
1215 Duff Ave
Ames, IA 50010-5469
Phone (515) 239-4400
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dthielen106664@directmcfarlandclinic.com | Health Information Exchange (HIE) |
Other providers in Jefferson, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.