Individual provider Active NPI

J.D. Thoreson, M.D.

  • Internal Medicine Physician
  • Mason City, IA
National Provider Identifier
1366430530
Registry record updated Dec 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
18110 Issued in IA
Practice address
250 S Crescent Dr
Mason City, IA 50401-2926
Phone
(641) 494-5350
Fax
(641) 494-5403
NPI assigned
Oct 11, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 18110 IA Primary

Addresses

Primary practice location

250 S Crescent Dr
Mason City, IA 50401-2926

Mailing address

250 S Crescent Dr
Mason City, IA 50401-2926
Phone (641) 494-5350

Other identifiers 1

IdentifierTypeStateIssuer
0044909MedicaidIA

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

State licenses

LicenseStateTypeSpecialty
18110IAMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419897600000",
    "number": "1366430530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 S CRESCENT DR",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504012926",
            "telephone_number": "641-494-5350",
            "fax_number": "641-494-5403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 S CRESCENT DR",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504012926",
            "telephone_number": "641-494-5350",
            "fax_number": "641-494-5403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THORESON",
        "first_name": "J.D.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-11",
        "last_updated": "2014-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "18110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0044909",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mason City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2014; 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.